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INSTRUCTIONS <br /> A sanitary perm!t ;< valid to, two (2) years. <br /> . . Yvr r san,itar permit : y he r.=,y. ew,'C swai any r.ew <br /> c itena i- the vV score -_,'rein: t de Code w. . ue app!!^a,".'u <br /> a r,, •^n5 �hls pr, ,,icr 3;•l- wN Ly Phe pt•mli ISSN irij aJi'lo nty. <br /> Changes I, o✓rnershi^ r -,hr•-requires a Sa ,;tarj ocrmir r rte r/Penewa! >=nrm r5E3p F3oa; to be <br /> submitted to the county prior <br /> 5 (nosite sewage cysterr -� et b e,criy tin - - �� -. �, <br /> � i r-� - S'• .� .r1,.! ., r .,_. be pumped by a !�:censc-d <br /> pumper whenever necessary t;aHv every c 3 years. <br /> 6. If you have questions concerning your cnsfte 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 /> L Property owner's name and mailing address. Provide the legal description and parcel tax numbers) of <br /> where the system is to be installed. <br /> IL Type of building being served. Check only one and complete a# o1 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 /> VII. Tank information. Fill in the capacity of every new and/or existing tank, ';st 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 till in name. license number with appropriate prefix he 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 riot smaller than 8Y2 11 inches must be submitted to the county. The <br /> plans must include the following. A plot plan, drawn to scala or with complete dimensions, location of <br /> holding tank(s), septic tank(s) or other treatment tanks, building sewerswells: 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 bedding served, B) horizontai 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 Lest 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 />