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INSTRUCTIONS <br /> P, sanitary permit is valid ro, two (2'; years. <br /> _. Your sanitary permn may be renewed before t'ne expiration nate, and at the time of renewal any new <br /> criteria in the Wisconsin Administrative Code will be applicable. <br /> J <br /> All r cion " this permil r,Ast b-- approviec ':y tiro x,arnid iss my authority. <br /> - '. hacges in ownarshla or o!umner requires a 'aor:ary f,cr. `T7ansfer!Rene•wal Foam !SBD 6^30! to be <br /> submitted to the Cor,nty prior ta,instaltaticr:. <br /> sew qc system mu.�' he r ely , nn, nc cept ti,iv l musf 7c pt mpeC b, c cc"cd <br /> GS�d j etre f: y,a, _ <br /> you f,ave questions cora:em,ng yu.r ons:t'� :3e,emgl sr -te;r1. contact your local ccde <br /> • .+f `h5c—ns'.n. Safety & 92 a n,.. <br /> ire :,r:plete anc accurate this sanitary he'rnit applic,tron T . J nclude <br /> Property owner's name and mailing adJ,es� Prcvloe he legal description and parcel tax numberfs+ or <br /> M, sy em is to ,a _lia!lad. <br /> ii Type of building being served. Check only one and complete # of beorooms if 1 or 2 =amily Dwelling <br /> !li Building use. It building type is Public, check ail appropriate boxes that apply. <br /> Iype of permit. Check only one in line A.. Complete fine B if permit 1s for tank replacement, recunneCron, or <br /> repair. <br /> Type of system. Check appropriate box depending ec sgstem type <br /> VI Absorption system information. Provide all information, requested in #1-7. <br /> 1; '-a;tk information. Fill in the caper ty c` eveiy new .;ndio,�existing tank listthe total g,.Jons, our l)sr <br /> tanks and manufacturer's name. indicate prem_: r site constructed and tank material. Complete :cr a'i <br /> septic, pump/siphon and holding tanks for this svao c,. Check experimental approval only if tanks received <br /> experimental product approval from DILHR. <br /> VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. <br /> MP, etc.), address and phone number. Plumber must sign application form. <br /> IX. County/Department Use Only. <br /> X. County/Department Use Only. <br /> Complete pians and specifications not smaller than 8'/� x 11 inches must be submitted to the county. The <br /> plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of <br /> holding tank(s), septic tanks) or other treatment tanks, building sewers; wells; water mains/water service, <br /> streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system <br /> areas; and the location of the building served, B) horizontal and vertical elevation reference points; <br /> C) complete specifications for pumps and controls; dose volume, elevation differences; friction loss; pump <br /> performance curve; pump model and pump manufacturer, D) cross section of the soil absorption system if <br /> -.� required by the county; E) soil,test data on a 115.form; and F) all sizing information._. <br /> --------------------------------------------------------------------------------------------------------------------------------------------------- <br /> GROUNDWATER'SURCHARGE <br /> 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of <br /> regulated practices which can effect groundwater. <br /> The monies collected through these surcharges are used for monitoring groundwater, ground- <br /> water contamination investigations and establishment of standards. <br /> SRF 639z M 1 186) <br />