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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 /> 2 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 /> Ail revision-ls to this pen-ttit must be approved by the permit issuing authcnty. A new permit may be needed <br /> If there is a change in your building pians, system location, estimated wastewater flow (number of bed- <br /> rooms, etc ), depth of system, or type of system, <br /> 4 Changes in ownership or plumber requires a Sanitary Permit Transfer/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 2 to 3 years, <br /> 6 !f you have ques'mr.r.s concerning your private sewage syatenr, contact your ocal code admmmstrator or 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 /> II Type of building or use served. If public is checked, indicate type of use (ie. 10 unit apartment, 30 seat <br /> restaurantetc i- Fill in number of bedrooms if building is a one or two family dwelling: <br /> III_ Purpose of application Check only one in 41. Complete#2 it permit is for tank replacement. reconnection or <br /> repair, <br /> IV Type of system check all appropriate boxes depending on system type. Check experimental only if project <br /> is in conjunction with University of Wisconsin, <br /> V. Absorption system information: Provide all information requested in #1-6: <br /> VI. Tank n ormaticn_ rill in the capacity of every new and!or existing tank �ictthe total gallons to be installed <br /> number of tanks and manufacturer's name- Indicate prefab or site constructed and tank material Complete <br /> for air septic.. IifVslphon chamber and holding tanks for this systern Check experimental aggro_ vat only if <br /> tanks received experimental product approval from DILRR, <br /> till. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g <br /> MP, etc.), address and phone number. Plumber must sign application form Fill m designer name if <br /> applicable: <br /> VIII. Sol[ test information Certified soil testers name. certification number, address, and phone number. <br /> IX. County/Department Use Only: <br /> X Comment area for rise by county ur resaon given when application is disapproved <br /> Complete plans and specifications not smaller than P'.' , 11 inchos Snmar be submitted to the county. Tre- <br /> Plans must include the toll:wing: A; plot plan, drawn to S-d!, oI vlth ccfnp:ete dimensions- location cf <br /> holding tank(st sept"- fan, s) - r other rrsatment tarF's; bu 7irg scv: r - w.e!fs. 4 _er ma:ns'water ,, <br /> streams and lakes- dosing or pumping r-i,ambers: distribution boxes snrl abs(aption systems. repler,emant <br /> SJStetT dr c 'i-e r-_'i J" :f if e i McjLlg sr rued, 61 'r .c c,r- !e <br /> I', .rr .ai �tevation refere;rr,e poin. <br /> C) con f :r to specifications for pumps and controls dose volurne, elevation differences. friction toss. pump <br /> performance curve; pump model and purrp manufacturer. D) cross section of tire sell absorption system if <br /> required by the county: F) soil test data on a 115 form. <br /> GROUNDWATER SURCHARGE <br /> On May 4. 1984. "r963 Wrsconsi r A,1 410 was signed r'ti; raw. Ti,' if rs,ar s more <br /> u 3i fti. r m :i i i fr.e <br /> J <br /> 6rcicrrr ..r c .,,. av ycini huluinu tar. .rrrput - <br /> � i <br /> «.gat <br /> Vl,o '. �trJ�.orb {'r; <br /> its worth protecting. <br /> SBU-6398 (R 03/8611 <br />