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INSTRUCTIONS <br /> .. ..anKary permit Is vatic fo two (2) year;. <br /> 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 w.il! be applicable. <br /> 2. A!! reels ons to this permit must be approved by the permit issuing authority. <br /> q. Changes in ownership or plumber requires a Sanitary Permit TransfeNRenewa! =orm (SBD 6399) to be <br /> submitted to the county prio, to installation <br /> 5 Onsite sewage systems must he properly maintained_ Th,e septic taak(s) must he pumped by a liconsed <br /> P: n,per vrheneoer necessary, osua;ly every 2 to 3 years. <br /> if you have questions concerning your onsite sewage system, contact your local code administratcr or the <br /> Siete of Wisconsin, Safety & Buildings Division, 608-266-3815 <br /> To he complete and accurate this sanitary permit application must include_ <br /> !- Property owner's name and mail-ng address Provide he legai description and parcel tax number(s) of <br /> where the system is to be insta!l(.d- <br /> 1!. Type of building being served. Check only one and complete ## of bedrooms it 1 or 2 Family Dwelling. <br /> !IL 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 /> V!. Absorption system information. Provide a!! information requested in 41 '. <br /> VIL Tank information. Fill in the capacity of every new and/or existing tank, list the total gailons, 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 experimental 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 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; 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(R-11/88) <br />