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INSTRUCTIONS
<br /> 1 A sanitary permit is valid for two j2) years
<br /> Your sanitary perrinit t., ewed :,ef,,;'v e 11,e !,me r' re-i-waf any new
<br /> criteria in the Wlscors!- AdIT Cocp w,i' be applicable.
<br /> 3 A!! revisij�)s to thi,,; pe,,r,o r,,usf be aporcvud by the peirnit iSSdi;ig dutriority.
<br /> Changes in ownership cr nh_imber requires a Sanitary Dc1r";T Form -GPD, 63991 to be
<br /> submitted to ;he county prior to ristallafio,�.
<br /> Onsite sewage sys'enris must he ornpn,ly ,jirlta;,ied FrIp sept' , !a.rk!s) mij<t be pumped by a ';censed
<br /> pumper whenever necessary, usually every 2 to 3 years.
<br /> 6 If you have questions concerriurig 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 /> 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 # 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 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. 'ist 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 /> VIII. Responsibility statement. Installing plumber is to fill jr, 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 riot smaller than 8,4 , 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 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; 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,
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<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)
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