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INSTRUCTIONS <br /> 1 A sanitary permit is valid for two (2) years. <br /> Your sanitary permit may be renewed betore the expiration date, and at the time of renewal any new <br /> criter.a in the Wisconsin Adm:^;strctive erode x^!' be applicable. <br /> All revis ons to this permit must be approved by the permit issuing authority_ <br /> 4. Changes in ownership or plumber requires a Sanitary Permit Transter/Renewal Form (SBD 6399) to be <br /> submitted to the county prior to installation. <br /> Onsite sewage systems must be properly mamtained. The septic tankis) must he pumped by a Ilcensed <br /> pun;per ,vhenever necessary, usually every 2 :u � yeais. <br /> 6 If you have questions concerning your onsite sewage system, contact your local code administrator nr the <br /> State of Wisconsin, Safety & Buildings Division, 608-266-3815. <br /> To be curnplete and accurate this sanitary permit application must include. <br /> Property ovinf:r s name and nlading address. Plov,rin 'he 1?191 deSCrintipn and parol fax numher(e1 of <br /> where the system is to be installed. <br /> 6 Type of building being served. Check only one and complete # of bodrnoms if t or 2 =amity Dwckiny_ <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 it 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, purnp/siphon and holding tanks for this system. Check experimental approval only if tanks received <br /> experimerial 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. <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 /> SBD-6398(R_1 1/88) <br />