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INSTRUCTIONS <br /> -I A sanitary permit is valid fe, two (2) ye-ars. <br /> Your samta-y perrnit n,y he ,e'twc'd hefn e the e:.;; -,' un Ga;c -,nd at !t.e )' rr newal any new <br /> criteria in the Wiscors Cude w :1 t.;; app;icable_ <br /> 3 All revisions to this pe rr ^rus? o aporrvrd by the Permit issuing authority. <br /> 4 Changes in ownership r ni�;mher requires . Sanitary Permit Form (SBD 5394) to be <br /> submitted to the county prior h- nstailat9:;n. <br /> Onsite sewage systems , be properly m, t.ntained ?he septi k2s1 must be pumped by a licensed <br /> pamper whenever necessary, every 2 to 3 years. <br /> 6 if you have questions corcerni no 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 /> 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 /> Il. 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 ;s 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, 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 and holding tanks for this system. Check experimental approval only 4 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 /> IX. County/Department Use Only. <br /> X. County/Department Use Only. <br /> Complete plans and specifications not smaller than 8'b 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 tanksbuilding 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. <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 /> SBO-6398(R.11/88) <br />