|
INFORMATION & INSTRUCTIONS FOR COMPLETING A. SANITARY PERMIT
<br /> APPLICATION
<br /> TO THE APPLICANT:
<br /> 1 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 will be applicable.
<br /> All revisions to this permit must be approved by the permit issuing authr:nty A new permit may be needed
<br /> if there ;s a change in your building plans, system location. estimated •mrastewater flow (number of bed-
<br /> rooms, etc ), depth of system_ or type of system,
<br /> Changes in ownership or plurnber requires a Sanitary Permit transferRenewal Form (SBD 6399) to be
<br /> submitted to the county prior to installation:
<br /> 5. Private sewage systems rnust be properly maintained. The septic tdnklsj should be pumped by a licensed
<br /> pumper whenever necessary, usually every 2 to 3 years;
<br /> ;` you have q❑eshons concrrPing your private sewage system co!ltact your local code administrator ;r the
<br /> State of Wisconsin, Bureau of Plumbing, 608-266-3815
<br /> To be complete and accurate this sanitary permit application must include.
<br /> 1. Property owner s name and mailing address. Provide the legal description where the system is to be
<br /> installed,
<br /> Type of building or use served If Public is checked.. indicate type of use (ie. 10 unit apartment. 30 seat
<br /> restaurant, etc.1. Fill 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 systemcheck all r,pprourfate boxes depending on system type- Check experimental only if project
<br /> is in conjunction with University of Wisconsin,
<br /> Absorption .system information. Provide all information requested in #1-6.
<br /> 0 Tank information. Fill In the caparn'y -r every new andior existing tank_ list the total gallonssto be in stalled,
<br /> number of tanks and manufact,:rer s name- Indicate prefab or site constructed and tank material. Complete
<br /> for JNseptic. !ft/siphon chamber and holding tanks for this system Check experimental approval only it
<br /> tanks received experimental product approval frorn DILHIR
<br /> ._. Responsibility statement- Installing Plumber is to fill in nam : iieenss n„rnber w-.th appropriate prefix le g
<br /> MP, etc.), address and phone number Plumber must sign application form. Fill in designer name if
<br /> applicable.
<br /> Vlll. Soil test information_ Certified soil fester's name, certification number. address, and phone number
<br /> IX. County/Department Use Only,
<br /> X Comment area for use by county or resai given when apphcatlor is dsapproved.
<br /> Complete plans and speci°icatc r s than 8'' f nches n_-'-t lie submitted to the county. The
<br /> plans mist include the foll,,Nin.g: At o plan, drawn to sea Cr with complete dimensions !ocatlot, e`
<br /> hotdiog tank(s',. se,�tic tank,) nr other :ea tmer4 tanks; bu Ir ng sewer.; well.: water rnalnshvater seg ^^e.-
<br /> streams and lakes. dosing or numpmo ( hambers, dish)hutnut boxes, sol: absorption systemsreplacement
<br /> syeter areasiriJ lI)e '�nc�t ..i ',i , tis ' L5) '-.;,lal -iT. evatipn reference points.
<br /> - complete srucifications for pumps and controls, dose volume: elevation differences (action loss: pump
<br /> performance curve, pump model and pump manufac'urei D) cross section of the soil absorption system if
<br /> required by the county; E) soil test data on a 115 form. .r
<br /> GROUNDWATER SURCHARGE
<br /> On May 4, 1984, 1983, NJisconsu A alt; v.-rs nfo "'v T h..
<br /> y
<br /> if, ., t 'r1ar' i,. tncI ,f tree r
<br /> .� ... ,i - C05@
<br /> c'� i � U '-Lir .
<br /> i, Site Asea by yJui oitioi,g j ..., . .�
<br /> C h_ DE, i .-.., ,
<br /> `_ a�rxlPma®wrt
<br /> wa ems, groAr,d water r„n i lu .:tet � an � r , r 1 ` ref s:a `^. '. rwl '.v✓t,iey.
<br /> i! worth protecting.
<br /> .1'D-6398 (R 03,'86)
<br />
|