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INSTRUCTIONS <br /> Y )Jr Sanitary permit may be rene'wpo before `e evp,ratror mate. and at the time of renewal any new <br /> criteria n the Wisconsin Admin:stral Coco •rrik be applicable. <br /> A[l r ri.� ,ris to 'his permit must he approved by the perm it ss;.ii y _uthority. <br /> Changes :n ownership or plumber requires a Sanitary Pre int Transt—lPenewai Form (SBD 6399} to be <br /> submitt=d to the county prior to mstallation. <br /> Ccistte sewage systems must he pro perry ma r,a,ned. "rne ccptic a,rs) mu,' br, pumped by a hcensod <br /> F;u! u: vv'he;ieer nece55ay, usCody evci ,, 2 r_ � yBa(_. <br /> n it you have questions concerning your onsite sewage system, contact your local code administrator or the <br /> State of Wisconsin, Safety & Buildings Dig,.:cion, 6609-266-'.615. <br /> 0 be c:,mple:e and a - Ovate this saritar; pe•m,t application mai include <br /> Ptope ty cwoer s name and mail`,' 3011 ess the desC--ori and parcel tax nurnber(s) 1Y <br /> vrhere tho- system s to be installed- <br /> If. Type of building being served. Check only one and complete n of bedrooms if 1 or 2 =amity Dwel;:ng. <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 if permit is for tank replacement, reconnection, or <br /> repair. <br /> ti Type of system Check appropriate box depending on system type <br /> V!. Pbscrptior system information.. Provide all infermaticr. eq <br /> � ,. .,^ ed <br /> sl. <br /> VII. Tank information. Fill in the capacity or every new andior 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 (e.g. <br /> MP, etc.), address and phone number Plumber must sign application term. <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.tt/BE) <br />