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INSTRUCTIONS <br /> -a-;!a r v pe-m ' is wi;fd two (12) years <br /> Y. r -,,a ,Maty pv::r.t r _y bc'w 'i), �F-Pwa any new <br /> cr e:.a in the Wis_,l - P <br /> ndeos: -,ns 'o Ib f'n 1 9;_;,f,)vt,1l lyy pe i M;l. s6 i­.g al.A,Mority. <br /> Cha'gns In ow�p�c-,.jip eq�i!rQ� a San:t&,,, rl,­­ Fnrm fSBr) C.3oq� 10 nc <br /> sj"-ttled To The �oun4v Pr c- to nstallation <br /> 5 0'lsite sewage r,�Is! he Pr,)rerlv r -Tafr-t-d lwiui­ rr st be pumped by a licensed <br /> pumper whenever necessary, usually every 2 to .3 yearr <br /> If you have questions concerning your onsite sewage system, contact your local code acm,nisilrater 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 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 /> Ill. 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/siphor, and holding tanks for this system. Check expermiental 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 /> IX. County/Department Use Only. <br /> X. County/Department Use Only. <br /> Complete plans and specifications not smaller than 8'G x 11 orches 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 iRA11/158) <br />