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INSTRUCTIONS <br /> I sanitary permit Is va,w In, two (2) years. <br /> Your sanitary permit r i, c xp,;at C" :_­1- t7* ime v1 rine <br /> new <br /> ci,teria at :he Wisi�orlStri y <br /> I ')e apple e <br /> � <br /> A;l recisions to this vpr.n I ' 4 l,­vod fry the ;De;m;t _16­ng authority. <br /> 4 Chances in ownership or phurrhe,, requires a San,tare Pp-,P:,- T-arsfer,Penewal Prrtn iS817 6199) lo be <br /> submitted to the County pr,C), to installation <br /> 5 Onsite sewage systems must be property maintained. The sep! c tankis, mutst be pumped by a Lcensed <br /> pumper whenever,necessary, usually every 2 to 3 years <br /> 6 If you have questions concerning your onsite sewage 5vstern, 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 <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 /> If Type of building being served. Check only one and complete # of bedrooms it 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 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 arid/or existing tank. list the total gallons, number of <br /> tanks and manufacturer's name Indicate prefab of 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 in name, license number with appropriate prefix (e.g <br /> MP, etc.), address and phone number. Plumber must sign application form <br /> X County/Department Use Only. <br /> K County/Department Use Only, <br /> Complete plans and specifications not smaller than 8'/ , 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; 0) 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 /> I <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(R.11/88) <br />