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INSTRUCTIONS
<br /> A -,amtary p�-n val,d v,, 12; vear_-
<br /> ar sanitary pp., nit l�- li,pe r,l ren,w,,i any il,w
<br /> cf-tel;a m ihe i
<br /> 3 A rev slors tc, tl, � p,,,ri . ..... 1,e oy pr mt ss-Ing &_tt,zir,ty.
<br /> 14 C-angr-s in ownership cr 4w;.et: Sariiiary Ti;InStril,Ao-ewaf Form fSPD ;i3Q9) to he
<br /> s,Nmi*tecl to the county pr o� ,c,
<br /> Onsite sewage systems nurz- be crpfiriv m;,i riti,n('d 71,e fanki'iill -us' be pumper! hy a !,cen,:ed
<br /> pumper whenever necessary. us,,a!!v Pve.r,,1 2 to 3 yea-
<br /> 6 If you have questions concerning you, onsite sewage system, c,311tact your local 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 /> 1. Property owner's name and maiiing address. Provide the legal description and parcel tax number(s) 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 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 (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 W/Y 11 inches trust 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 /> 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(811/88)
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