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INFORMATION & INSTRUCTIONS FOR COMPLETING A SANT WARY 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 authority. A new permit maybe needed <br /> if there is a change in your building plans, system 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 (SBO 6399) to be <br /> submitted to the county prior to installation; <br /> 5- Private sewage systerns must be properly maintained. The septic tank(s) should be pumped by a licensed <br /> pumper whenever necessary, usually every 2 to 3 years. <br /> 6- If you have questions concerning your private sewage system, contact your local code admimstrator 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 al/septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if <br /> tanks received experimental product approval from DILHR. <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'f, 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 Wiseo m'S <br /> can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure <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 /> he monies collected through these surcharges are credited to the groundwater fund admims- ° <br /> tered by the Department of Natural Resources. These funds are used for monitoring ground- <br /> water, groundwater contamination investigations and establishment of standards. Groundwater, <br /> it'; worth protecting. <br /> S6iD-6398(R.03/86) <br />