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INSTRUCTIONS <br /> A sanita,V perrr,� is .�'�!d fc- two i2) years. <br /> -. Your sr r,.,<,ry pe mit ma; ' o er _N ' [e'.,r._ ,. ne .,` renewal any new <br /> onteria un the rV�scoos!� _. t ;e Csdc F ;e apps cable. <br /> Al +ev >.ocs t F.cx, ;^.° ,r e;i U= the oe rmq issuing a4. ,utity. <br /> ,4 fl4nano es i❑ uw ,ership or p4u ober requires a. „a ,',:3ry ' :rit TransfeclAenewal Fcrm SSD 63g9j to be <br /> -submitted to ti-,e county prlof to installation. <br /> 5 Onsite sewage systems ,rust be prooer!y maintained The serol tarki, mast be pumped by a fi^erse;, <br /> pumper whenever necessary, usually every 2 to 3 years <br /> If you have questions concerning your onsite sewage system, contact your local code administratnr o• the <br /> State of Wisconsin, Safety R 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 numberls) of <br /> where the system is to be installed. <br /> li. Type of building being served. Check only one and complete # of bedrooms it 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 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 le.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 8Y, x 11 inches must be submitted to the county The <br /> plans must include the fol!owing. 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(11.11/88) <br />