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INSTRUCTIONS <br /> 1 .. sanfa-y pe—ri-It is valid for two (2) years. <br /> 1'uur saritary permit.na ' -e« xp r of -ac ar ha_ me, o* .�newe' any new <br /> crlle-ia in !he VJ,sconssn 1 m n..,, ve Cock wiii 'ie app,catle. <br /> 3 All si ;ons t h ;, pear r �.,�, �..r a,,p,oved by Lhe Petnlll, isscing a '.bonfy. <br /> t Changes in cN r e,Fh r or pi.jmbor requires a Sanitary Pp,nn,t T:ansfer-Renewal Form (SBD 6399) to be <br /> si_bmitted to the county prier to installation. <br /> Onsite sewage systems rust be p�o, -rly ma.ntwned 'rhe sepiv; tanks) roust he pumped by a licensed <br /> pamper whenever necessary. :.sually every 2 to 3 years <br /> 6 If you have questions concerning your onsite sewage system, contact your local code administator or the <br /> State of Wisconsin, Safety 8 Buildings Division, 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 and parcel tax number(s) of <br /> where the system is to be installed. <br /> II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. <br /> III. Building use. If building type is Public, check all appropriate boxes that apply. <br /> IV. Type of permit. Check only one in line A. Complete line 6 if permit is for tank replacement, reconnection, or <br /> repair. <br /> V Type of system. Check appropriate box depending on system type. <br /> VI. Absorption system information. Provide all information requested in #1-7. <br /> VII. Tank information Fill in the capacity of every new and/or existing tank, list the total gallons, number of <br /> tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for al/ <br /> septic, pump/siphon and holding tanks for this system_ 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 plans and specifications not smaller than 8'F , 11 inches must be submitted to the county. The <br /> plans must include the following A) plot pian, 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 /> 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 /> SBD-6398(RA 1/88) <br />