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INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMI-1 <br /> APPLICATION <br /> TO THE APPLICANT: <br /> 1. This sanitary permit is valid for two (2) years, <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 Administrative Code will be applicable, <br /> 3. All revisions to this permit must be approved by the permit issuing authority A new permit may be needed <br /> if there !s a change in your building planssystem location. estimated wastewater flow (number of bed- <br /> rooms, etc.), depth of system. or type of system.. <br /> 4. Changes in ownership or plumber requires a Sanitary Perwil Transfers Henewal Form ISBD 63991 to be. <br /> submitted to the county prior to installation. <br /> 5. 'Private sewage systems must be properly maintained. The septic tankjs) should be pumped by a licensed <br /> pumper whenever necessary, usually every 2 to 3 years, <br /> 6. If you have questions concerning your private sewage system, contact your local code administrator or the <br /> State of Wisconsin, Bureau of Plumbing, 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 where the system is to be <br /> installed; <br /> II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat <br /> restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling: <br /> III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or <br /> repair, <br /> IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project <br /> is in conjunction with University of Wisconsin: <br /> V. Absorption system information: Provide all information requested in #1-6: <br /> VI. Tank information: Fill in the capacity of every new and/or existing tank. list the total gallons to be installed, <br /> number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete <br /> for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if <br /> tanks received experimental product approval from DILHR: <br /> VII. 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. Fill in designer name if <br /> applicable: <br /> VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. <br /> IX. County/Department Use Only, <br /> X. Comment area for use by county or resaon given when application is disapproved. <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; dosing or pumping chambers; distribution boxes: soil absorption systems; replacement <br /> system 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. <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> GROUNDWATER SURCHARGE <br /> On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more <br /> commonly known as the.groundwater protection law. This change in statutes was the <br /> result of over 2 years of steady negotiation and public debate. The groundwater bill Ground later <br /> included the creation of surcharges (fees) for a number of regulated practices which Wiscor.Lh'.In"s' A <br /> can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure / y <br /> is used in your building is returned to the groundwater through your soil absorption o <br /> system or the disposal site used by your holding tank pumper. <br /> The monies collected through these surcharges are credited to the groundwater fund adminis- <br /> tered by the Department of Natural Resources. These funds are used for monitoring ground- t <br /> water, groundwater contamination investigations and establishment of standards. Groundwater, <br /> it's worth protecting. <br /> SBD-6398(R 03/86) <br />