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INSTRUCTIONS
<br /> A sanitary permit is valid for two (2) years.
<br /> Yo_ir sanitary p-1,—lit it ',; e we,t heft's f :',e ':,re 1 ou^lewal any new
<br /> criteria in, the 'Wiccons A -i, ,
<br /> 3 Al: rG.,SICnF to this pr r N ;,f�pr t' by the Germii ss,.i^,y auti,onty.
<br /> d. Charges nw.,crsrip 7a Sa :tart F,,r:^i! T _r'rz,enewa' Fn-m ISBD g3p9t 'o be
<br /> s,cr,ctted to the .run pt (1r t.. isladat,o a.
<br /> Ooslte Sewage systems m art be p. pv iv rrP. ,ainad rpA must be pumper, by a ',censed
<br /> . —,per whenever necessary. ❑sualiy every 2 to 3 years
<br /> 6 1+ you have, questions ccncern:ng your onsite sewage system, contact your local code administrator 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 /> I. Property owner's name and mailing address. Provide the legal description and parcel tax numbers) 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, list 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 systerr.. 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'h < 11 inches must be submitted to the county. The
<br /> plans must include the following. A) plot pian, 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; BJ 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.
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<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)
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