|
INSTRUCTIONS
<br /> &ar,!":1'v 0_� mi, is Va d f, Twe 2; years
<br /> yp sar tar, rm
<br /> rreh
<br /> critcna
<br /> Ali t,- th �l, p, tr,,;[ hy p2'rlit issi%, ng authur ty.
<br /> A Changes in ownership �r plhx�)!rie, requnec, a oan!ta-v Pir.,.—r-, T,:j,,�;1e,Renewar Fnrm SHiD- io be
<br /> submitted tco the ccunty prior to nstaliaii,en
<br /> 5. Onsile sewage sysierns ,iiirt be rir,)perly ilratntaf-jed n.e sPrii", to iosl n!!ist he pumped, by a lice^sed
<br /> purriper whenever necessary, .,Sua!ly every 2 to 3 years,
<br /> 1
<br /> 6 If you have questions concerning your onsite sewage system, contact your local code adm:nistraior 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 number(s) of
<br /> where the system is to be installed.
<br /> 11 Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
<br /> 111. 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 6 if permit is for tank replacement, reconnection, or
<br /> repair.
<br /> V. Type of system. Check appropriate box depending on system type.
<br /> Vt. Absorption system information Provide all information requested in #1-7,
<br /> VII. Tank information Fill in the capacity of very new and/or existing tank, list the total gallons, number of
<br /> tanks and manufacturer's name. Indicate prefab o, site constructed and tank material Complete for all
<br /> septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
<br /> experimental product approval from DILHR.
<br /> Vill, 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 /> X County/Department Use Only.
<br /> X. County/Department Use Only.
<br /> Complete plans and specifications not smaller than 8'/'2 , 11 inches must be submitted to the county The
<br /> plans must include the following Aj p'Gt plan, drawn tu scale or with complete dimensions, location of
<br /> holding tank(s), septic tank(s) or other treatment tanks, building sewers; webs; 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 /> ------------------—-—----—----------------—-—----—------------------------------------------------------------—---------—-------------------—--
<br /> GROUNDWATER SURCHARGE
<br /> 1983 Wisconsin Act 410 included the creation of surcharges (fees) tor 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 />
|