1994/11/09 - SANITARY - SAN - Other

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INSTRUCTIONS ., pan„ ry peon,,, „ :al, !wu (2) yea;.,. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new ':marl' -n the Wisconsr^ 'Qm!c:stratl`ie Cod^'rr•• he apphcablo. Ali •av,sioos to this )moot must be apprwc� cby the permit issujr,g authority. A. Changes In ownership or plumber requires a Sanitary Permit Transter+Rer-wal Form (SBD 63991 to be submitted to the county prior to installation. C^�ite sewage systems must tic pr2perty rralnta!ned- The septic tanks; must be pumped by a licensed wh' V'e! lleCGbs"' ", t yAr,' }, ," "ai 6 if you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815 To be cornplete and accurate this sanitary permit application must include - Property owner's name end ma!hr", td'lless r „gide the legal descnpt,on and parcel tax nuroher(si of where th, system is to be ins•al'ed. + Type of :tiding being served .;heck on;y one and om, c, 2 Farm!, Dwclki:—. In Building use. If building type !s Punh,, check all appropriate boxes that apply. !V. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. Type of system Check appropriate box depending or system type. V! Ahsorphcn system information. Provide at information requested in #!1 T '.'li. Tank information. Fill in the capao--iy or every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a!/ septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers, wells, water mains/water service, streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD 6398(R.1 1/82;