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INfFORI'll & INSTRUCTIONS FOR COMPLETING A SANITARY PER.MIT,
<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 /> All reviswms to this permit must be approved by the peer t -suing authcrrty_ A new permit may be needed
<br /> ;fthere is a changs in your building planssystem locatioe. estimated maste.vatpr flow (number of bed-
<br /> rooms, etc 1, depth of system, or type of system,
<br /> 4 Changes In ownership or plumber requires a Sanitary Permit R ansfer,Renewai Form (SBD 6399) to be
<br /> submitted to the county prior to installation,
<br /> 5. Private sewage systems must be properly maintained. The sciatic tanks) should be pumped by a hconsed
<br /> pumper whenever necessary, usually every 2 to 3 years.
<br /> 5. If you have que .;tines -oncorm!,g your private sewage system, contact your ocsi code admiristra'or 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 /> I. Property owners 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 (i e. 10 unit apartment, 30 seat
<br /> restaurant, etc ). Fill in number of bedrooms if building is a one or two family dwelling,
<br /> lil. Purpose of application: Check only one in ##1. Complete ##2 it permit is for tank replacement. reconnection or
<br /> repair,
<br /> I`d. 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 /> Absorption system information- Provide all information requested in ##1-6.
<br /> VI Tank informatior FII in the dpac;ty of every new and/or existing tank st the total gallons to heinstalled
<br /> eurnher of tanks rid manufacturers name. Indicate prefab or site constructed and tank mttetali Complete
<br /> for a/1 sepPc, lift/siphon chamber and holding tanks fol this system. Che<k experimental ,pr.,--� nal only i+
<br /> tanks received experimental product approval from DILHR,
<br /> 1/II Responsibility statement Installing plurnber is to fill m narnr. iicerse ru,mber with appropriate prefix fe.g
<br /> MP, etc-). address and phone number Plumber must sign application form Fit in designer name if
<br /> applicable:
<br /> VIII Soil test information- Certified soil tester s name, certification number. address, and phone number.
<br /> IX. County/Department Use Only,
<br /> X- Comment area fen use by county er r esaon given when application is disapproved.
<br /> Complete plans and specifications ;lot srna!ie.r Char, 8'-. 11 f fiches must be submitted to the county -h(-
<br /> plans must 'include rbc following:Rj p' ,f F ardrawe to seal( er with C,-:'. plete mri-sion cation of
<br /> holding tank(s';, septic tani nr other rrcatmr,,rfa-,kr;, builu c- sAw r Aeiis v _.ter ma s'wRter - �ic^-
<br /> streams and lakes norma or pumping chambers distribut o(l snil absorpLun systwr,s. replae,emenf
<br /> n a-, a + �( nee' ,f tee o, ir:g s S' i•--tai 1 .r ,.at2 evatior ete.re nCe• pnints-
<br /> C cnr� k to �,:ealicatl,ns for pumps ane controls dose volumeelevation differences. friction loss. p:nnp
<br /> Derfon ,dree curve f :amp model and Pu11 ma f urer; D) cross sc tion of the s,il aht„ip6on sys.ern if
<br /> required by the county. E) soil test data on a 115 form
<br /> GROUNDWATER SURCHARGE
<br /> Oo May A 1984. 1983 Wisconsin Acf 410, was sigr-,ed into law Tis egla!d'iorp, IF p s mere
<br /> . . 1 ev
<br /> year„ _f ;ieu�} .;:.._ ... . 1,osis. he , v ,fP .. li Grou,
<br /> ;..wator - `
<br /> 9m or t le ❑Is Cuaa .,,iiJ un C.; JV V"ui innuilW :Sign ..0 r Flu,
<br /> Ci
<br /> it s worth protecting. -
<br /> SBD-66981R 03/861
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