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INSTRUCTIONS <br /> I A sanitary permit Is va!iu for twu (2) years. <br /> 2. Your sanitary permit may be renewed before the expiration dateand at the time of renewal any new <br /> Criteria in 'fie Wiscon-L A.dmir!strativc Codi vrC :,c appfcabls. <br /> 3. All revisions to this permit must be approved by the permit Issuing authatity. <br /> A Changes in ownership or p!umber requires a Sanitary Perm:t. TransterrHenewal Form (SBD 63995 to be <br /> submitted to the County prior to, insta!laticr, <br /> 5 Onsite sewage systems must tic p oNr,y rra r+a;nod. The „optic Mn!'!` must he pumped by a licensed <br /> pU t,ri whu u.,er necab6ary ....,'. a iy .. v,, . .,- 3 boa;,, <br /> 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the <br /> STafe rf Nisoonsin, Safety & Buildings Division, <br /> 7o be ,omplete and accurate this sanitary permit application must include <br /> ! Property owner's name and mauling address. Provide the legal description and parcel tax m.unber(s) of <br /> vv Flt:a y:vterr. is to be instaliet:. <br /> k Type of building being served. Check only one and complete o! bto oorns if 1 of 2 �auiuy Dwelling. <br /> Ili. Building use. It building type is Public, check all appropriate boxes that apply. <br /> IV Type of permit. Check only one in line A. Complete fine B it permit is for tank replacement, reconnection, or <br /> repair. <br /> Type of system- Check appropriate box depending oa system type. <br /> VI Absorption system information. Provide alt information requested in 4 <br /> 1 '. <br /> Vli. Tank information. Fill in the capacity ul every new andior existing tart,, list the total gaiions, cumber of <br /> tanks and manufacturer's name. Indicate prefah or site constructed and tank material. Complete for a / <br /> septic, pump/siphon and holding tanks for this sy=_tem. 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 Corm. <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 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 /> --------------------------------------------------------------------------------------------------------------------------------------------------------- <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 /> SBD6398 in 11/88) <br />