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INSTRUCTIONS <br /> 1. A sanitary permit is valid for two(2)years. <br /> 2. Your sanitary permit maybe 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 ownership or plumber 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 concerning your onsite sewage system, contact your local code administrator or the State 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 mailing address. Provide the iegai description and parcel tax number's)of where the <br /> system is to be installed. <br /> IL 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 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 all septic, 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 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 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 />