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INSTRUCTIONS <br /> 1. ., sanitary perm'i is ,,ii '_; two j2) yeais <br /> _. yow sanitary permit n _ .._ -wed befra _ -s t wa:c ,,d s't 'ns. ' m .� <br /> p e �enawal any n,-w <br /> C.Nler(a ut the Wisccns � t ative Code wit! he applicabie. <br /> A;! rP,'sion= to this pa, ,r a ^rover ov the <br /> p, per mit issuing authority. <br /> h Changes in ownership or p It T..ber requires a Sanitary Permit TransferlRenewal Fnrm iSBD 6399, to be <br /> s:_hmitte:7 to tYIe ::runty prior to nstallation. <br /> 5. Onsite sewage systems must be properly rna;itained. The septic tank!s� must be pumped by a licensed <br /> pumper wherever 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 <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 /> Ill. 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 /> 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 a// <br /> septic, pump/siphon and holding tanks for this systern. 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 81. 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; pump or siphon tanks; distribution boxes, soil absorption systems; replacement system <br /> areas, and the location of the building served; 8) 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 /> -------------------------------------------------------------------------------------------------------------------------------------------- <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-6396(R.11/88) <br />