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INSTRUCTIONS <br /> A. sanitary perm,t 's valid for two i2) years. <br /> `-sur sanitary permit .y Lie c �-i het. c, r,:z _ . . -. v '''c ,^.e of 1 arewai any new <br /> cr e.r,a in +,,e :.ee Ce J 'JU apply—L:e. <br /> �. A, E ;i.�r, ,^ th�� pi.in mus` N ppr-,r. ' ;lit u,g a"!hurity. <br /> 4. C arges n cvnershir• jr n!umcer requires , t1crclt T, ,rs*er-nern•wa! rcrm9BD 6399` to be <br /> S, bmitted tr, `he count, oror to i ahanor.. - - <br /> secaage systo- must he r^?e- mn tp,-rd he ;err 3^«�.=. .^ . be. um ed - a <br /> � _ p p cy licensed <br /> 0,r :;per whenever neves ary, usr I:y every 2 to 3 years. <br /> 6 If you have questions concerning your onsite sewage system, Contact your iocal code admmistrator cr the <br /> State of Wisconsin, Safety & Buildings Division,1608-266-3815. <br /> To be.complete and accurate this sanitary permit application must include' <br /> 1. 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 # o1 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 N line A. Complete line B it 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 manufacturers name. Indicate prefab or site constructed and tank material. Complete for al/ <br /> septic, pumpisiphon and holding tanks for this system. Check experimental approval only if tanks received <br /> experimental product approval from DILHR. <br /> Vlll. 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 sma!ler than 8'n' ., 11 inches must be submitted to the county. The <br /> plans must include the following. A) plot pian., drawn to scaie or with compiete dimensions, location of <br /> hoiding 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. Bi 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 sgrcharges are used for monitoring groundwater. ground- <br /> water contamination investigations and establishment of standards. <br /> SBD-6398(R.11/88) <br />