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NFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT -
<br /> APPLICATION
<br /> TO THE APPLICANT:
<br /> 11 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 perm'n ssulng authol ry A new permit may be needed
<br /> if there is a change in your building plans, system locationestimated wastewater flow (number of bed
<br /> -
<br /> roums. et(.). depth of system. or type of system.
<br /> 4. Changes in ownership of plumber regwres a Sanitary Permit Transfer/Rerewal I (SED 6399) to he
<br /> submitted to the county prior to installation.
<br /> ii Pnvate sewage systems must be properly maintained. The septic taniysi should be pumped by a licensed
<br /> pumper whenever necessaryusually every 2 to 3 years.
<br /> If you have questions cw ('E nirtg your private sewage syatemcentart your local code admirnistrator cr 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 /> I!. Type of building or use served: If public is checked, indicate type of use (Le. 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 #I Complete #2 it permit is for tank replacement, reconnection e
<br /> repair,
<br /> I',, Type of systemcheck all appropriate boxes depending on system type. Check experimental only if project
<br /> is in conjunction with University of Wisconsin.
<br /> 'i Absorption system informat,or, Provide all information requested in #1-6:
<br /> '✓I Tank informarior._ Fill n the capacity Ill every new drdrer e.xistirc, tank, !iSl the total gallons to bt nsialled,
<br /> number of tanks and rnal'tarer; name Indicate prefab or site constructed and tank material. Complete
<br /> for a//Sept " lift/siphon chambe, and holchrig tanks `ur thr system Check experimental approval only if
<br /> tanks received experimental product approval from DILHR;
<br /> VJ Responsibility statement Installing plumber !s to fill In name, license nJnrher with appropriate prefix le g
<br /> MP, etc.), address and phone number. Plumber must sign application form. Fill 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 for use by county or resaon given when application is disapproved.
<br /> Complete plans am_, specificar ons rot a Mer ff.arl 811 - inches nru,t be submitted to Y e cot:❑t, -'c
<br /> plans iusf include the folkMng: r, I, o, ; ar.. drawn to sua r ur a:ith complete dimensions, r/;at'or o'
<br /> holding tanks) septic tank ,),r nth, Tie tmer te.rks b. irt�rg etv r le lls; ,nater mains water service:
<br /> dreams and lake, do,;mg or pomnri r r,ambers di,,i,, on bone; s „l absorption sysierns. replacement
<br /> ';V !'If ''c: . a t O� ',1 •t il'2 , 'liJ St`i yr i 1;, i ,.r,zkr l a , Jr!_a i,evat'o, referor ce po,nls
<br /> J; corriplele specifications for pumps and controls; dose volume; elevation differences, friction loss: pump
<br /> performance curve, pump model and pur*g1 manufacturer, D) cross sectio; of the soil abscirption gstun, if
<br /> required by the county, E) soil test data on a 115 form.
<br /> GROUNDWATER SURCHARGE
<br /> Or, May 4 1984 ?983 Jv sconsi , 4 io reti
<br /> ..�, . .. tie
<br /> 'Ys !,I
<br /> it's worth protecting.
<br /> SB0-6398 IR 03/86)
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