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INSTRUCTIONS
<br /> A sanitary pern�t Is vali(" twc (2) years
<br /> Vo r san,taiy pe -,It rrt, . r.rr held ,_ _ .. :wz: any new
<br /> crter;a in the Wisconsi _! ative Code !,e apah _
<br /> F+I r-vtn,,ms h; pe_,m ,,,J. I. t,;drove'. civ ;;-,e ;:e so,� ig a,a!Icr ty.
<br /> Ch gns in ownership e, pl+embe, requires a Sanitary a ,r ,.t.Tann stvr,Renewal Form ISBD 63991 to be
<br /> submitted to ,,e teunty pr os to ;nstallatiun.
<br /> 5 On,ite sewage systems n. ,st be ; .{.eriy rn- inta,nedl T?.e ser!-,: m-,K;s) mast be pumped by a t censeu
<br /> pumper whenever necessary, usua!ly every 2 to 3 years.
<br /> 6. If you have questions concerning your ons!te sewage system, contact you, local code admicstrator or Phe
<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 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 /> 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 if tanks received
<br /> experimental product approval from DILHR.
<br /> VIII. Responsibility statement. Installing plumber is to fill in name, license member 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 scaie 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; 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.11188)
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