Form Sbd 6398 PDF Details

Navigating the process of obtaining a sanitary permit can be complex, yet it is a critical step for ensuring the safety and compliance of various types of buildings within Wisconsin. The SBD-6398 form stands as a cornerstone in this journey, serving multiple purposes from new system installations, replacements, to modifications of existing sanitary systems. This form is utilized by property owners, constructors, and plumbers who are engaging in projects that require the state's approval for sanitary installations. The detailed sections within the form guide applicants through providing comprehensive information about the project site, type of building, and specifics about the type of Privately Owned Wastewater Treatment Systems (POWTS) that will be installed or modified. The form also delves into the design aspects of the disposal or treatment area, including the capacity and type of tanks to be used, ensuring that all installations comply with the Comm 83.21, Wisconsin Administrative Code. Emphasizing privacy, it adheres to privacy laws, ensuring that personal information is protected yet utilized appropriately for secondary purposes as outlined by the state law. With a stringent review process indicated by the provision for approval or denial, the SBD-6398 form underscores the Wisconsin Safety and Buildings Division's commitment to maintaining public health and environmental integrity through meticulous sanitary system regulation.

QuestionAnswer
Form NameForm Sbd 6398
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesWetland, VII, sanitary permit blank form, gpdsf

Form Preview Example

 

Safety and Buildings Division

County

 

201 W. Washington Ave., P.O. Box 7162

 

 

Madison, WI 53707 – 7162

 

 

Sanitary Permit Number (to be filled in by Co.)

 

(608) 266-3151

 

 

 

 

Sanitary Permit Application

State Plan I.D. Number

 

In accord with Comm 83.21, Wis. Adm. Code, personal information you provide

 

may be used for secondary purposes Privacy Law, s15.04(1)(m)

Project Address (if different than mailing address)

I. Application Information – Please Print All Information

Property Owner’s Name

Parcel #

Lot #

Block #

Property Owner’s Mailing Address

City, State

Zip Code

Phone Number

 

 

 

II. Type of Building (check all that apply)

1 or 2 Family Dwelling – Number of Bedrooms _______________________________________________

Public/Commercial – Describe Use _________________________________________________________

State Owned – Describe Use _________________________________________________________

Property Location

 

 

 

 

 

 

 

¼,

 

 

¼, Section _______

 

 

 

 

 

 

(circle one)

T

 

 

N; R

 

 

E

or

W

 

Subdivision Name

 

 

 

 

CSM Number

City_Village Township of_________

III. Type of Permit: (Check only one box on line A. Complete line B if applicable)

A.

New System

Replacement System

Treatment/Holding Tank Replacement Only

Other Modification to Existing System

 

 

 

 

 

 

 

B.

Permit Renewal

Permit Revision

Change of

Permit Transfer to New

List Previous Permit Number and Date Issued

 

 

Before Expiration

 

Plumber

Owner

 

 

 

 

 

 

 

IV. Type of POWTS System: (Check all that apply)

Non –Pressurized In-Ground

Mound > 24 in. of suitable soil

Mound < 24 in. of suitable soil

At-Grade

 

Single Pass Sand Filter

 

Constructed Wetland

Pressurized In-Ground Holding Tank

Peat Filter Aerobic Treatment Unit Recirculating Sand Filter

Recirculating Synthetic Media Filter

Leaching Chamber

Drip Line Gravel-less Pipe Other (explain)

 

 

 

 

 

 

 

 

 

V. Dispersal/Treatment Area Information:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Design Flow (gpd)

 

 

Design Soil Application Rate(gpdsf)

Dispersal Area Required (sf)

Dispersal Area Proposed (sf)

 

System Elevation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VI. Tank Info

 

 

 

Capacity in

 

 

Total

Number

 

Manufacturer

 

 

Prefab

 

 

 

Site

Steel

 

Fiber

 

Plastic

 

 

 

 

Gallons

 

 

Gallons

of Units

 

 

 

 

 

Concrete

 

Constructed

 

 

Glass

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New

 

Existing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tanks

 

Tanks

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Septic or Holding Tank

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Aerobic Treatment Unit

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dosing Chamber

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.

 

 

 

Plumber’s Name (Print)

 

 

 

 

Plumber’s Signature

 

 

 

MP/MPRS Number

 

 

 

 

Business Phone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Plumber’s Address (Street, City, State, Zip Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VIII. County/Department Use Only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approved

Disapproved

 

 

 

 

Sanitary Permit Fee (includes Groundwater

 

Date Issued

 

 

Issuing Agent Signature (No Stamps)

 

 

 

 

Surcharge Fee)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner Given Reason for Denial

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IX. Conditions of Approval/Reasons for Disapproval

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size

 

 

 

 

 

SBD-6398 (R. 01/03)

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1. It's important to fill out the Wetland correctly, hence be careful while filling out the parts containing all of these blanks:

Step number 1 of submitting VII

2. Just after performing the previous step, go to the subsequent part and fill out all required particulars in these blanks - IV Type of POWTS System Check all, Design Soil Application Rategpdsf, Dispersal Area Proposed sf, Dispersal Area Required sf, System Elevation, VI Tank Info, Capacity in, Gallons, Total, Gallons, Number of Units, Manufacturer, Prefab, Site, and Steel.

Ways to prepare VII stage 2

Always be very careful when filling out Design Soil Application Rategpdsf and VI Tank Info, as this is where a lot of people make mistakes.

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