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INSTRUCTIONS
<br /> 1. ;+ sanitary pe,imit is valid ter two fl-, years.
<br /> -. oi,1 3a r,'.:�. ry pa-:,r.; a t, w, , o , e ea:; , -Jo:, ;ia�i i,..G ae time ct r-newal eny r.ew
<br /> u .., in the ,Y ,c,&, �, A, ,r;i,?i,irative Code wi!i be applicable.
<br /> ;�1I .swri ,> this per,ii, mu,'. be approved 'vy the permit issuing authority.
<br /> 1-v ,=,shi u'umne, -s a Sa^italy Permit T ^-fer/".enewal F-.Yr, ;SBD 6. 9.
<br /> F - N'' 3 9i tU be
<br /> ,subrr tied to the county prior to instailation.
<br /> .. Orsl:e sewage systems must be p'openy maintained. The septle tank(s) must be pumped by a licensed
<br /> pumper whenever necessary, usually every 2 to 3 years.
<br /> 6. If you. have questions concerning 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 /> 11. 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 isfor 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 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 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.
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<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 /> 58D-6398(P.11'88)
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