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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 /> 3. All revisions to this permit must be approved by the permit issuing authority A new permit may be needed
<br /> if there is a change in your building plans, 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- If you have questions concernim your private sewage system- contact your local code administrator 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 /> III. Purpose of application. Check only one in #$1. Complete 42 if 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 01-6�
<br /> Vl Tank information. Fill in the, capacity of every new and/or existing tank, fist the total gallons to be installed,
<br /> number of tanks and manufacturers name Indicate prefab or site constructed and tank material Complete
<br /> for all septic, lift/siphon chamber and holding tanks fur ih,s system. Check experimental approval only if
<br /> tanks received experimental product approval from DILHR..
<br /> VII. Responsibility staterrient Installing plumber is to fill in namelicense numha_r with appropriate prefix (e g.
<br /> MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name If
<br /> applicable,
<br /> Will Soil test information; Certified soil :esters name. certification number. address, and phone number
<br /> IX. County/Department Use Only,
<br /> X. Comment area for use by county or resaon given when apphcalicn is disappreved-
<br /> Complete plans and specifications rot small'= tha, 81 inches rtst be submitted to tht- county The
<br /> plans must include the following: A) 7u? plan, drawn to scale, or w th complete dimensions. locatian of
<br /> holding tank(s). septic tankiN or other t-eat,iert tanks br dint, srwe water mains'water service
<br /> streams and lakes: dosing or pumping (,:,ambers d-5nlbunon boxes seal absorpuoo sy3temsreplacement
<br /> systen areas a ,' the !oca „ _ ,� �irsg ntltve,i B; c z_oot:al ,r ,c,'i,;a! elevation reference po,nts
<br /> C) complete specifications for pumps and controlsdose volumeelevation differences; friction loss; pump
<br /> performance curve, pump model and pump manufacicret D) cross section of the soil absorption system if
<br /> required by the county, E) soil test data on a 115 form.
<br /> GROUNDWATER SURCHARGE
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<br /> SHO-6398IR 03,86)
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