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INSTRUCTIONS <br /> A Sanitary permit is valid io: iwu i2'/ years. <br /> 2. Your sanitary permit may be renewed before the expiration date. and at the time of renewal any new <br /> criteria in thr Wisconsin Ad^t mstrative Codc vvi!I be applicable. <br /> 3 Ail re-�isions to this perrniT must be approved by the permit isscing authority. <br /> 4_ Changes in ownership or plumber requires a Scmiary Permir Transfer'Renewal Forr (SBD 8399; to be <br /> submitted to the county prim- to installation <br /> ti Onsite sewage system must s!ntwne"_.- The septic tank,!s; must be pumped by a Licensed <br /> p., [.v '.ih , ieJer rte eSSar y, ,i �i d :;vel _ .eai o. . <br /> 6 If you have questions concerning your onsite sewage system, contact your local code administrator or the <br /> State of `Nis^onsin, Safety & Bui! in-� r,8-�'6',, '815. <br /> To be complete and accurate this sanitary permit application must include: <br /> I Property owner's. name and mailing address F�rov,de the legal description and parcel tax numbers) of <br /> where the systern is tc be installed. <br /> II. Type of building being served. Check omy one and complete 4 of bedrooms it 1 of 2 Family Dwelling, <br /> Ili. Building use. It building type is Public, check all appropriate boxes that apply. <br /> IV. Type of permit. Check only one in line A. Complete line B d 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 informattloo requested in, ##1 7. <br /> VII. Tank information. Fill in the capacity o= every new and/or existing tank, list the total gallons, number cf <br /> tanks and manufacturer's name. Indicate pre?ab 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 8Y= 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 /> sao-rasa in.1 veel <br />