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INSTRUCTIONS <br /> 1 a sanitary permit Is valid fnr two (2) years. <br /> `c�r samtary permit . , hr, -t,r,r- v ! „e1;; r ;ht- =sp rat, r,ri i3O,- ir 1.' .: the ',me �, irenewai any new <br /> .; item in the Wis(;or.s Admo, will ;)e applicable- <br /> ,. A!� to thl, pe,-) nt,st rw rp;rr-vc 1 by The permit isswng authority. <br /> a Changes n c,w Gersh,,: or ip,umb-, equirc a Sana^ nPrautzterPorewal f"rrm iSBD 6399! to be <br /> r rated to the c uanty pr`c, to :nstalla8or. <br /> 5 Onsite sewage systems milt hF r nerly mntained The ser* a'.4`s? m,)s! be pumped by a lice.^.sed <br /> pur.:per whenever r.ectssan„ ..isually every l to 3 years. <br /> 6. i` 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 /> If 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 tanklist the total gallons, number of <br /> tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for al/ <br /> septic, pump siphon and holding tanks for this system. Check experimental approval only if tanks received <br /> experimental product approval from DILHR. <br /> Vill 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'h 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 /> 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 /> SBD-6398(R.11/88) <br />