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INSTRUCTIONS ` <br /> A sanitary rerntit Is vain 15� t•r.;; ��i years. <br /> 2 Your sanitary permit may be renewed before the expiration date. and a[ the time of renewal any new <br /> criteria in the Wisconsin Ad .!,n:stratve !:ed-- '11! be applicable. <br /> All Ievis!ons to this perm` must be approved by the permit issuing authority. <br /> Changes in ownership or plumber requires Sanitary Permit Transfer-%Renewal Form (SBD V,99! to be <br /> submitted to the county prig toIristallation <br /> - <br /> C�nsite sewage systems must be pr-en?-K. ma'mtalned. The septic tam:lsl mus' be pumpedI:cansed <br /> pu npCi wherever necessary, Useai y evefy 2 iu i yeaio. <br /> 6. !4 you have questions concerning your onsite sewage system, contact your local code administrator or the <br /> State of Wisconsin, Safety & Bwldings Division. 608-266-3815. <br /> o be complete and accurate this sanitary permit application must Include <br /> Property owner's name and mailing address Prev"de 'he legal description and parcel tax numher(s ^ <br /> ` ' <br /> ,rhe `-e system is to be nst, !leil. <br /> h. Type of building being served Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. <br /> 11I. Building use. It building type is Public, check all appropriate boxes that apply. <br /> IV. Type of permit. Check only one in tine A Complete line B it permit is for tank replacement, reconnection, or <br /> repair. <br /> Type at system Check appropriate box depending ori system type <br /> V!. Absorption system information.. Provide all information requested in R1 7. <br /> \ill. Tank information. Fill in the capacity or every new andior existing tank, list the total ga;lons, 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 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 /> IX. County/Department Use Only. <br /> X. County/Department Use Only. <br /> Complete plans and specifications not smaller than 8'/� x 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 <br /> sYr stem <br /> streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement <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 /> --------------------------------------------------------------------------------------------------------------------------------------------------------- <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 /> ssD-sage(R.11/88) <br />