2008/05/30 - SANITARY - SAN - Other

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INSTRUCTIONS I ary pe 'rlit IIS va -4 lj� "Vry �cr Ye31 o. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new cnterla in the Wisconsin Administrative Code w!11 be applicable. .'til rsvislons fo this permit must be.. approved by .he perrn!t issuing authority. n Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBU 6399) to be submitted to the county prior to nstallation- ,. Onsite sawage systems must be properly ma:ntamed. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. - h If you have questions concerning your onsite sewage system, contact your local code administrator or the - State. of Wis.^opsin, Safety & Buildings Division, 608-266-3815 To be complete and accurate this sanitary permit application must include: o.operty owner's name and mailing address D,m—le the legal description and parcel tax number(s) of where the system is to be instalied- il. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling - M Building use. If building type is Public, check all appropriate boxes that apply. !V. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair v Type of system. Check appropriate box depending on system type. VI Absorption system informatior. Provide all information requested in ##1-7. ,Ah Tank information. Fill in the capacity of every new and/or existing lank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. 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. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 81/� 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; pump or siphon tanks; 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; and F) all sizing information. ------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. - SBD 6398(R 11188)