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INSTRUCTIONS <br /> i ?. sanitary permit is valid for two (2) years- <br /> ,.. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new <br /> criteria in the 'N!scons^ Adm;nistr2tive Cad^ he applicab!c. <br /> 3. All revisions to this permit most be approved by the permit issuing authority. <br /> 4 Changes in ownership or plumber requires a Sanitary Permit Transfer'Renewal Form (SBD 6399) to be <br /> submitted to the county prior to installation. <br /> 5 C,nsite sewage systems mus- he properly rmrtmne�. The septic tank!sl must he pumped by a licensed <br /> I,u!,;r)e y. _,,,, y cSe, r 2 w y,afo <br /> 6. if you r ave questions concerning your onsite sewage system, contact your local code administrator or the <br /> State of Wisconsie. Safety & 8t_wc,ngs Division, 608-266-3815. <br /> To be complete and accurate this sanitary permit application mus` include. <br /> Property owner's name and ma!hn; ac!d_res= rrr:ide the legal description and parse, tax mumher(s,, ^' <br /> wh3-e th- system is tc beast ileo'_ <br /> N. Type of building being served. Check only one and cornple,e # of bedrooms if 1 or 2 Family Dwel,iny_ <br /> lh. Building use. it building type is Public, check all appropriate boxes that apply. <br /> IV. Type of permit. Check only one in line A_ Complete line B it permit is for tank replacement, reconnection, or <br /> repair. <br /> Type of system Check appropriate box depending or; system type <br /> VI Absorption system information Provide all information requested in #1-7. <br /> `Jil_ Tank information. Fill in the capacity 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 ail <br /> septic, purnp/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 81z 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 contam nation investigations and establishment of standards <br /> SBD-63961R 11/63! <br />