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INSTRUCTIONS <br /> 1_ A sanitary permit is valid for two(2)years. <br /> 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the <br /> Wisconsin Administrative Code will be applicable. <br /> 3. All revisions to this permit must be approved by the permit issuing authority. <br /> 4. Changes in ownersnip or piumber requires a Sanitary Permit Transfer/Renewal Form (SBD-6399) to be submitted to the <br /> county prior to installation <br /> 5- Onsite sewage systems must be properly maintained The septic tank(s) must be pumped by a licensed pumper whenever <br /> necessary, usually every 2 to 3 years <br /> 6 If you have questions concerningy,y r onsite sewage system, contact your local code administrator or the St.-te of <br /> Wisconsin, Safety and Buildings Division, 608-266-3815 <br /> To be complete and accurate this sanitary permit application must include: <br /> Property owner's name and riailing address Provide the legal descriptign and parcel tax number's )of where the <br /> system is to be installed <br /> I. Type of building being served. Check only one and complete #of bedrooms if 1 or 2 Family Dwelling_ <br /> M. Building use. If building type is public, check all appropriate boxes that apply. <br /> IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair_ <br /> V Type of system. Check appropriate box depending on system type. <br /> VI. Absorption system information. Provide all information requested for numbers 1 through 7. <br /> VII_ Tank information_ Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and <br /> manufacturer's name, indicate prefab or site constructed and tank material Complete for aNseptic, pump/siphon and <br /> holding tanks for this system. Check experimental approval only if tanks received experimental product approval from <br /> DILHR. <br /> VIII_ Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), <br /> address and phone number. Plumber must sign application form. <br /> IX. County/Department Use Only. <br /> X. County/Department Use Only. <br /> Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county_ The plans must <br /> include the following. A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic <br /> tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon <br /> tanks; distribution boxes; soil absorption systems; replacement system areas, and the location of the building served; <br /> B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls, dose volume; <br /> elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section <br /> of the soil absorption system if required by the county; E) soil test data on a 1 15 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 regulated practices which can <br /> effect groundwater <br /> The monies collected through these surcharges are used for monitoring groundwater contamination investigations <br /> and establishment of standards. <br />