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INSTRUCTIONS
<br /> 1. A sanitary permit is valid for two(2)years.
<br /> 2. Your sanitary permit may be renewed before the expiration date,and at a time of renewal any new criteria in the
<br /> Wisconsin Administrative Code will be applicable.
<br /> 3. All revisions to this permit must be approved by the permit issuing authority.
<br /> 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD-6399)to be submitted to the
<br /> county prior to installation
<br /> 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
<br /> necessary, usually every 2 to 3 years.
<br /> 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
<br /> Wisconsin,Safety and Buildings Division, 608-266-3151.
<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 where the
<br /> 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 /> III Building use If building type is public, check all appropriate boxes that apply
<br /> iV T'{pe of perms t ['tl P_Ck only one on i!rle A_ Complete line 8 if perm;t+s 1c�r tank replacement, i Erronnection, ar repolr
<br /> V fype of system. appropriate box dcoc ni^,, or,system type
<br /> V; Ei, , I t,-Pn syst� r :n'artnwir,Y� r� 't E' :� �„o''rF ti't(,:. :'li �.c,t�o Gi ,1;s �' _.1r"+t Gt'
<br /> V11 Tank;nf9rmatinn F1II tri the vapor Ity of every r!eWl(lr . vtst.. (l idr`Ik, iiS1, iile t. „a- Cjallons, r,l.imhei'Gt to ilk}ants
<br /> .. .. ..ti < <..: .� .:i .,, 'fit' "gym E)lele fCtr�I// 'f 12t1 p r vii ,14 f
<br /> C, l Tl sl J'7 Elil'.
<br /> tanks fof li>SGS ,-+Y; C.iltr',h eXpi"I f`ae-151 r't r;l r :a 'r . c0 1t:,i p C) L2,1aiJi)rC' tit
<br /> � iHR.
<br /> V!1; Responsibility staternent Instai:mg plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc-;,
<br /> 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 8 112 x 1 1 inches muss.be submitted to the county The plans must
<br /> include the following: A) plot play dr ,an „o stale or w f h compete dimensions, location of holding tank(s),septic
<br /> tank(s)or other tre?atmenY tanks, bU Icii;,"j seJvNcts, wells, "Vater main$/water S.,rJiCe, streams .,'id lakes, pump or siphon
<br /> t]-' s: dlstnbUtion boxes, soil absorptiC- Cys t""S, ep .ii,—,, n ,y_it'.rel cife3s, and the location c),i-_lle fJUl din g S^FY:?
<br /> B) horizontal and Vertical elevation reterence po. i C) _—Ijrnpelt-spec-tic itlrw)s for pumps and Controls; dose oi-)t^.c,
<br /> eievanon differences, friction loss; pump performance curve; pump model and pump manufa(turer; D) cross section
<br /> of the soil absorption system if 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 regulated practices which can
<br /> effect groundwater.
<br /> The monies collected through these surcharges are used for monitoring groundwater contamination investigations
<br /> and establishment of.standards.
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