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INSTRUCTIONS <br /> 1- A sanitary permits valid for twu i2) year,_ <br /> 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new <br /> criteria in the Wisconsin Adm:n:strative Code w,t! ^e appiicabie. <br /> 3. All revisions to this permit must ce approved b,, ere pen, , Issci ly authority. <br /> 4. Changes in ownership or plumber requires a Sanrtary Permit Transfer/Renewal Form (SLD 6399; to be <br /> submitted to the county prior to installation. <br /> Onsite sewage systems must be properly mamtair,ed. !he septic tare(s) mus' be pumped by a licensed <br /> pumper whenever necessary, usually every 2 to 3 years <br /> - - <br /> 6. If you have questions concerning ,your onsite sewage system, contact your local code administrato, cr the <br /> State of Wisconsin, Safety & Buildings Division,.608-266-3815. <br /> To be complete and accurate this sanitary permit application must include. <br /> Property owner's name and ma,i,ng address. r _ e the iegal description and parcel fax number(sl ^' <br /> where the system is to be installed. <br /> li. Type of building being served. Check omy one and complete # df bedrooms if 1 or 2 Family Dwelling. <br /> III. Building use. If building type is Public, check all appropriate boxes that apply. <br /> 1V. 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 o,. system type <br /> VI Absorption system information. Provide all i.^,formatinn requested in #' ?. <br /> VII. Tank information. Fill in the capacity o, every new and/or existing tank, iist the total gallons, riumber 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 (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 81/z 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 tanks) 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(19.11/88) <br />