2007/08/28 - SANITARY - SAN - Other

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INSTRUCTIONS sani,a ry pernril ;a �al,d fa two (7_) year— 'our sarntat; perms' may oe renewed before tn,� :.xpi. e on oai a,;,,, at the time u4 renewa, any new _rle- . ,,, the Wiscons.- Ccd '!! app!:",b! ,. /,t' !o this per. '1 must be apprcved by tare permit issuing authority. a ,;hanges in ownership or plumber reyn:res a Sanitary Permit Transfer'Renewal Form (SBD 6399) to be submitted to the county prior to 'Tistallation_ vn..rt„ seW Iqe, systems nrst he pro, ertv natmzrncd. The septic tanf;lsl most be pumped by a licensed 6. i' you have questions concerning your onsite sewage system, contact your local code administrator or the State rd Wisconsin. Safety & Bui!dings Dw, s!on 60a-?15E, 3815 c be csmplete and accurate this sanitary permit application must include: Property owner's name and mailing address- Pr^vide the legal description and parcel tax number(s) of wt:ere tte system is to be installed. if Type of building being served. Check only one anti coma e. - of u-droorns if 1 or 2 Fanw, Dwelling_ III. Building use. It building type is Public, check all appropriate boxes that apply. Iii Type of permit. Check only one in line A. Complete hne B it permit is for tank replacement, reconnection, or repair Type of system Check appropriate boy depending an system type V!. .Absorption system information.. Provide all informatirn requested rn 1, 1-7. VII Tank information Fill in the capacity o` every new and/or existing tank, list the total gallons number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete `•or a// septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc— address and phone number. Plumber must sign application form. !X. County/Department Use Only. X. County/Department Use Only. Complete= plans and specifications not smaller than 8'/� x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas, and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve, pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. -------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contarnination investigations and establishment of standards. SBD-6398(R.11/88;