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INSTRUCTIONS <br /> i A sanitary permit is valid for two (2) years. <br /> 2. Your sanitary permit may be renewed befcrre 'Ire expiral:on date. and al the t:me of renewal any new <br /> criteria in the Wisconsin Code will be appiicable. <br /> u. All revisions to this permit must be approved by the permit issuing authority. <br /> 4 Changes in ownership nr plumoer requires a Sanitary Permit T-ansfe,;Penewal F—m. !SBD 6399! to be <br /> sucmitted to the county prior to nstallation. <br /> 5. Onsite sewage s stems must be r^perry rna!ntaioed. The se tic t=nk!c1 + <br /> Y p � p _ ., m�..;st be pumper, by a licensed <br /> pumper whenever necessary, usually every,2 In 3 years. <br /> 6 If you have questions concerning your onsite sewage system, contact your local code administrator nr the <br /> State of Wisconsin, Safety & 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 B 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 /> VI!. 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 a// <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 W4 x 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 tank(s) 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(R.11/88) <br />