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INSTRUCTIONS
<br /> P. sain tary permit s valid i, r two (2% years.
<br /> L
<br /> yu,,� sar.!!,�ry pe,oll t :�t� e .,rne ,.,f 1eo..J any new
<br /> the 4-scor,
<br /> pei-n- ved by ;the permit iss.wig aLtnonty.
<br /> I Chanesin FtrZ
<br /> I , a Sanitar,Y Orrm!t -1-�-qfp.,2Renewal Fr.— (SBr, �399) to be
<br /> subln.fteC. ir *ne czllntly prior V, �staiiat,oi.
<br /> Orqitr, --,Pu;age system= —o5, he in-cpe,'; air*a rirrd "hr, ser,!- ti-*fs!, must be, pumped by a licensed
<br /> p,:,nper whenever necessar., jsjaliy e,,c.y 2 to 3 years
<br /> if You have questions concerning yc-,;r nris;te sewage system, contact your local code administrator cr 'he
<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 /> Ill. 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 /> vlj. Tank information. Fill in the capacity of every rew and/(,,r 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
<br /> /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 8Y , 11 inches must be submitted to the county The
<br /> plans must include the following At plot pian, oravio to s=ale 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, 9) 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.tPici 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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