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INSTRUCTIONS <br /> 1_ A sanitary permit is valid tow two (2) years. <br /> Your sanitary pe^nit n­,ay be ^ewed befr'e 'hc ex, alw,, da - and of he ;me r` renewal any new <br /> criteria in the Wisconsin �,,e appiicable. <br /> .3 All revisions to alis p r rbe approved t v the permit iss:ing a:lhotity. <br /> .. Changes it ownership ^.r nlember requircs, a Sancta ,, Permit T-ansfco9ene•x2' Fora i>BD 6399! to be <br /> submiifed to the county prier to nstallancn. <br /> 5 Jnsite sewaga syste-ns mr;sf br- Pr-)Pc-iv a rta,rled The .,nkis) 'st he pumperf by a licensed <br /> pumper whenever necessary, usually every 2 to 3 years. <br /> 6 If you have questions concerning your onsite sewage system, contact your !coal code admlmi.stratr 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 mailing address. Provide the legal description and parcel tax number(s) of <br /> where the system is to be installed. <br /> II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. <br /> III. 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., !ist 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 exper:mental 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 I x 11 inches must be submitted to the county. The <br /> plans must include the following. A) plot plan, drawn to scale or with cornplete dimensions, location of <br /> holding tank(s), septic tank(s) or other treatment tanks, building sewerswells, water mains/water service'.. <br /> streams and lakes, pump or siphon tanks: distribution boxes; soil ahsorption systems: replacement system <br /> areas, and the location of the building served, B) horizonta: 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(R.11/88) <br />