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INSTRUCTIONS <br /> sanitary permit is valid for two (2) years. <br /> ,our sanitary permit may be renewed before the expiration date. and at the time of renewal any new <br /> criteria in the Wisconsin .Administrative Code will be applicable. <br /> All revisions to this permit must be approved by the permit issuing authority. <br /> A Changes in ownership or plumber requires a Sanitary Perm!t Tr insfer/Renewal Fo,; (SEID 6399) to be <br /> submitted tot the county prior to installation <br /> C-^site sewage systems must bd properly maintained. -rhe seprr tar (s; mutt he pumped t)y a licensed <br /> .rptar wherneve•• necessary, usually eve,, 2 to 3 years <br /> r r <br /> if you have questions concerning your onsite sewage skf-em, contact your local code admini,;tramr c, the <br /> S a',e of Wisconsin. Safety & Buildings Division. 60B-?66-3315 <br /> be complete and a,"curate this sanit, ry pefrmit application must mcl.)de: <br /> Property owner's name and mailing address. Provtds-, the legal de�icrtption and parcel tax number(s) of <br /> where "e. system: is to, be installed <br /> Type of building being served. Check oi,iy one and cump!ei 1# of L:edrooms if 1 or 2 Family Rweliing. <br /> III. Building use. If building type is Public, check all appropriate boxes that apply. <br /> 1%1 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 n ##1-7. <br /> VII Tank information. Fill in the capacity of every new and/or existing rank, list the total gallons, number of <br /> tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all f" <br /> septic, pump/siphon and holding tanks for this system. Check exp( rimental approval only if tanks received <br /> experimental product approval from DILHR. <br /> VIII. 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 applicat on form. <br /> IX. County/Department Use Only. <br /> X. County/Department Use Only. <br /> Complete plans and specifications not smaller than 8Yz x 11 inches must be submitted to the county. The <br /> plans must include the following: A) plot plan, drawn to scale or w-th 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 siding 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 groundwafbr `ground " '- <br /> water contamination investigations and establishment of standards. j <br /> SBD-6398(R.11/88) <br />