2008/07/09 - SANITARY - SAN - Other - 14063

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INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT., APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years: 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable, 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans. system location, estimated wastewater flow (number of bed- roomsetc.). depth of system, or type of system, 4. Changes in ownership or plumber requires a Sanitary Permit Transfer,Renewal Form iSBD 6399) to he submitted to the county prior to installation, 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6- If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815 To be complete and accurate this sanitary permit application must include: I Property owner's name and mailing address. Provide the legal description where the system is to be installed: II. Type of building or use served. If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling: III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair, IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin, V. Absorption system information: Provide all information requested in #1-6: VI_ Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for al/septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR, VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix e.g MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable: VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only, X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes, dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served, B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ----------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the ('� result of over 2 years of steady negotiation and public debate. The groundwater bill Groundwater— included the creation of surcharges (fees) for a number of regulated practices which Wiscor144in"s can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasuire is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86)