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INFORMATION & INSTRUCTIONS FOR COMPLETING 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 /> 3 All revisions to this permit must be approved by the permit issuing authonfy. A new permit may be needed <br /> if there is a change in your building planssystem location, estimated wastewater flow (number of bed- <br /> rooms, etc.)- depth of system, or type of system, <br /> 4_ Changes in ownership or plumber requires a Sanitary Permit Transfer%Renewal Form (SBD 63991 to be <br /> submitted to the county prior to installation, <br /> 5- Private sewage systems must be prdperly maintained. The septic tank(s) should be pumped by a licensed <br /> pumper whenever necessaryusually every 2 to 3 years_ <br /> 6- If you have questions concerning your private sewage system. contact your local code administrator or 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 owner's 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 (i.e. 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 #1. Complete #2 if permit is for tank replacement, reconnection or <br /> repair, <br /> IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project <br /> is in conjunction with University of Wisconsin, <br /> V Absorption system information. Provide all information requested in #1-6; <br /> VI_ Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, <br /> number of tanks and manufacturers name. Indicate prefab or site constructed and tank material. Complete <br /> for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if <br /> tanks received experimental product approval from DILRR, <br /> VII. 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. 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 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 tank(s) or other treatment tanks; building sewers; wells, water mains/water service; <br /> streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement <br /> system 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. <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> GROUNDWATER SURCHARGE <br /> On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more <br /> commonly known as the groundwater protection law. This change in statutes was the <br /> result of over 2 years of steady negotiation and public debate. The groundwater bill Ground Ater =� <br /> included the creation of surcharges (fees) for a number of regulated practices which Wisco in`s A /� <br /> can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that burled }}reasure ,/ ` VI <br /> is used in your building is returned to the groundwater through your soil absorption o <br /> system or the disposal site used by your holding tank pumper. ) <br /> c <br /> The monies collected through these surcharges are credited to the groundwater fund adminis- <br /> tered by the Department of Natural Resources. These funds are used for monitoring ground- t <br /> water, groundwater contamination investigations and establishment of standards. Groundwater, <br /> it's worth protecting. <br /> SBD-6398(R.03/86) <br />