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INFORMATION & INSTRUCTIONS FOR COWLETING 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 /> All revisions to this permit must be approved by the permit issuing autf:orrty A new permit may be reeded
<br /> it there is a change in your building plans, system locationestimated wastewater flow (number of bed-
<br /> rooms, etc.), depth of system, or type of system,
<br /> 4- Changes In ownership ur plumber requires a Sanitary Permit Transfers Renewal Forrn (SBD 6399) to he
<br /> submitted to the county prior to installation:
<br /> 5. Private sewage systems must be properly maintained. The septic tankls, she:.ld be pumped by a licensed
<br /> pumper whenever necessary, usually eve-y 2 to 3 years
<br /> 6 If you have questions a7n-erning your private sewage sync r. contact your log a'. code adn,inistrater 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 /> 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 Compiete #2 it permit is for tank replacement, reconnection of
<br /> repair,
<br /> IV Tyne cf systemcheck all appropriate boxes depending on system type. Check experimental only if project
<br /> is .n conjunction with Un�.verslty of Wisconsin,
<br /> V Absorption system information. Provide all information requested it, #1-6.
<br /> VI Tank iotormatro rat in the capacity of every new andior existing tank. i6st the total gallons to be inslailed,
<br /> number of tanks and manufacturer's name. Indicate prefab or site constructe+! and tank material Complete
<br /> for all septic, lift siphon chamber an] holding larks !orihls system. Check experimental approval only If
<br /> tanks received experimental product approval from D11-HR.
<br /> VII. Respo 1s;blhfy statement. Installirig plumber fs to fill in nam-., license 11L.mlher 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 /> VIII Soil test information_ Certified soi' tester's name, certification number, addressand phone number.
<br /> IX. County/Departrnent Use Only,
<br /> X. Comment area for use by county or esaon given when application s disapproved.
<br /> Gornpl-le pla.,is :nd specifications not mallei than 8'4 , 11 inches mi.st be submitted to the county The
<br /> plans n!st include the fPllowing Aj plot plan, drawn to erase or wit c-,-p!,-;e dimension', ocat'lon of
<br /> ho!din ta,k(z;, septic tank's) or other . S«-mem ,,.i ht-riding sev r se` ;re
<br /> streams and rakes, dosing or pumping chambersdisiribuhon boxes snJ aosoi I hon systems. replacement
<br /> sy=ter u. ,_s. a u rt c. Deal .r o! tha t c, r ,�i t; rer vi I. B , r zorita; .r . , . rti o.;i invaticn refererre points:
<br /> Cj eon fklLlu specifications for pumps and eontr( ls, dose volume. elevation differences: friction loss. pump
<br /> performance curve; pump model and pump r,rar .ufacturer. D) cross ser.tion eI the soil ab rF `c,n system if
<br /> required by the coonfy: Fj soil test data on a 115 form.. -
<br /> GROUNDWATER SURCHARGE
<br /> On May 4, 1984, i963Wisconsin Act 410 was signed into law- This iegisa
<br /> i , o:- a more
<br /> /c1: if cg�t'a:c _ (C f o .r dw3'c 'urn Groundwater
<br /> .v... ... _ vu�..�.. ,..., ..SG:. JV vVul nOitLill] .r. r w
<br /> it-s worth protecting.
<br /> SBD-6398 i,R.03,,861
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