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INSTRUCTIONS <br /> A sanitary permit is valid for two (2) years <br /> 2Yc.,;r sa.iita,y porrint 3y cc, "Ved be!o o r anv new <br /> CnIeria n the Wiscors in app hcable. <br /> e,,sw,is cr;l, vUtl by !!.0 isst ing auttwnty. <br /> 4 'f-anges r rw,e,sh-r or -r !oqL:;-eS 7,1 SaTlItZI-1 ^rrn 'oenC.v;aj Fn,. :SHP, 6399� *o be <br /> submitted to the --cor-y prior rr,n ,stallat,on, <br /> 5 Ons:te sewage systems n­,,sl he protm-ly Orairtalried he se,-',!- t 1"*;s, —Lirt be PUMPCO Cy al ; onsed <br /> pumper whenever- nPiCesSary uSi,arly 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 /> 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 it permit is for tank replacement, reconnection, or <br /> repair. <br /> V Type of system. Check appropriate box depending or. 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 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 /> IX. County/Department Use Only. <br /> X. County/Department Use Only. <br /> Complete plans and specifications not smaller than 2Yz 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 lank(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; 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) 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(RA 1/88) <br />