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'NF1 RMATIOIN a INSTRUCTIONS FOR COMPLETING A SANT tlAPY PERMIT
<br /> APPLICATION
<br /> TO THE APPLICANT:
<br /> This sanitary permit is valid for two (2) years:
<br /> ?. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
<br /> criteria in the Wisconsin Administrative Code wilt be applicable.
<br /> ? All revision's to this permit roust be approved by the porn rasumg aurhunty. A new permit may be needed
<br /> f tfrere is a change in your building planssystem location. estimated wastewater flow (number of bed
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<br /> roonis, etc.), depth of system, or type of system;
<br /> 4_ Changes in ow to ship or plumber requires a Sanitary Per.,,, Trans(er,Renewal Form (SBD 6399) to be
<br /> submitted to the county prior to installation;
<br /> 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed
<br /> pumper whenever necessary, usually every ' to 3 years,
<br /> ti ''f you 'lave questir r con erurng yu ur ,;rivate sewage sy,tem, coo'a.+ r-r�lr local code a Jrrr 3rirator or thei
<br /> State of Wisconsin. Bureau of Plumbing, 608-266-3815.
<br /> To be complete and accurate this sanitary permit application must include.
<br /> Property owners name and mailing address. Provide the legal description where the system is to be
<br /> installed.
<br /> L'_ Type of building of use served- It public is checked. ncdicate type of use (ia. 10 unit apartment. 30 seat
<br /> restaurant, etc.). FIN in number of bedrooms if building is a one or two family dwelling,
<br /> III. Purpose of application_ Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or
<br /> repair,
<br /> IV Type of system. check all appropriate boxes depending or. system type- Check experimental only If project
<br /> is in conjunction with University of Wisconsin,
<br /> V. Ahsorpnon system information: Provide all information requested in #1-6
<br /> Tank Information Fdr in tt e .apacity of every new urdiur existing tank '.ist the total gallon„ tc be in. a!IoC
<br /> number of tanks and manufacturer ,. name. Indicate prefah r,rsite ron truc,ed and tank material Complete
<br /> for sb septi., I'.fI s,phw chamber ane' hcldmg tank-, for- thl system; Check ck experimental app,-;val only if
<br /> tanks received experimental prnduct approvai from DILHR.
<br /> ,,It Responstbillty statement installing Plumber is to fill in nacre. license number with appropriate prefix (e g
<br /> MP, etc.), address and phone number Plumber must sign application form Fitt in designer name if
<br /> applicable:
<br /> Vill, Suit test information_ Certified soil testers name. eonticatcon number rjclj!ess, and khone number
<br /> IX. County/Department Use Only,
<br /> X Comment area for use by courlte or resaon given wrier- appi,c'cfioc is disapproved
<br /> Comp eta p ane, and specticat ores riot inalier 'n^ g=;. � ' inches rt , :1 be submitt '
<br /> ed to ,e aJunry. Tr
<br /> plans n ,s' ;nc''.ude !h' foil rx ig A) , ?t I.Ian, r awe, to s r c.r :, ',h wplefe 'iT.en6lon ativ c n'
<br /> holdin J to k(s) sent:,- tank r ^t rp..= r . r n'nanre t:-'..: bc, d setw r
<br /> Streams anti lakes ottynq p r rlmomo 6-5Ii ort ern boxes V I abS1lrf4101- SylfeunS. repla(ement
<br /> ay'S10^ area'. n . ir'cr r r r r r e, , r A iU� IeVatiOn r�1e rr n s
<br /> �r'3 rri fee E o'nt_
<br /> C: co „retie specific atlors for pumps anc rontrcls close volumeeievaron dlfterences; friction loss. pump
<br /> performance curve, pump model and pump n;;r,.,fact jfui D) cross oection of the soil albsorot,,ri system if
<br /> required by the county E) soil test data on at 115 form.
<br /> GROUNDWATER SURCHARGE
<br /> On May 4 1584. 1983 Wrsconsl A, i4 ,s h,v. ;hi, legrsf J
<br /> - t Of "i, you. � � & .wJ y.,,. � c .:.,L ..;L�:� y �Jr dA J's L:IJ �irOul7d Water __
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<br /> UScu Jr, vuu, .110H,J ...ki...
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<br /> �.�: qu.Ur� .r ,1 r, yr ' ,� c •. J i r �i JeJB bar r_..
<br /> Its worth protecting
<br /> SBD-6398 (R 03,86,
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