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INSTRUCTIONS
<br /> san,!ary Penit is valid 'c; iwci (21; years.
<br /> 7 sa,,itaiy pr'."![" ; 1, t 0 'D " il " 'A- - , :,t, - r,, i! �� , t I-e
<br /> the M„Cf,n_: . -,�jr 1 Code Altie aPlp;,Ca�'e
<br /> ev,sinns 'o this per: t us'
<br /> ti;,,„over, Jy ;! ;; N -nl;
<br /> harlgFs In 0`vrer"Ilp require- a San,tary Dern-t 1,crjster Renewai ;:,rfn,
<br /> sur :lifted to the COUnly 'r to � ,;tai,ation 5. be
<br /> Ons to sowFge sy5ipw, r!�ut', he pr(�pe,lv ")ornta,�'d rt,o lHn,(s) rmst be purnped by a -reiised
<br /> pumper whenever recessar�, isiia,ly every 2 to 3 years.
<br /> 6 If you have questions concerning your onsite sewage systern, contact your focal 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 numberis) of
<br /> where the system is to be installed.
<br /> 11 Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling
<br /> 111. 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 lank 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 /> 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% 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.
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<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)
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