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INSTRUCTIONS <br /> sanitary iir, s c years <br /> "cut sa:­tal y purmilt. <br /> Cf `cria in rhF, <br /> AI re.vislo;13 IC <br /> Changes iC nwHersh;p nr at,­ Ia, Pen­! T94e 'Re,,wai Frirrin fSBD 63P9) to be <br /> rotted to the county p:.cr to ristaiiat,or <br /> Onsite sewage syslem, —u�! bp tr,�De,lv rnal,!!ai�pd '-�)il ta-K�sl must bp puntped by a licensed <br /> pumper eherever necessary, usually every 2 to 3 years <br /> 6 if you have questions concerning your onsite sewage systeirn, contact 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 /> I. Property owner's name and mailing address. Provide the legal description and parcel tax numbers) 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 6 if permit is for tank replacement, reconnection, or <br /> repair. <br /> V Type of system. Check appropriate box depending on system type. <br /> V1. 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, i,st 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 /> 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 /> IK County/Department Use Only. <br /> K County/Department Use Only. <br /> Complete plans and specifications not smaller than 8"" 1 Inches must be submitted to the county. The <br /> plans must include the following A) plot place, d!awr to scale or with complete dimensions, location of <br /> holding tank(s), septic tank(s) or other treatment tanks. Luilding 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 B1 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.11/88) <br />