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INSTRUCTIONS <br /> A sanit,i;y permit Is valid for two (2) year. <br /> .' Your sanitar <br /> y permit may oe renewed before the expiration date, 3n�7 at the time o: renewal any new <br /> criteria in the Wisconsin Administrative Codc will be applicable. <br /> 3 Alt ra:lslons to this permit must be approved b, the permit isscing authority. <br /> 4. Changes in ownership or plumber requires a Sanitary Perm;!_ Transirr'Renewal Form (StD 6393; to be <br /> submitted to, the county prior to installation. <br /> Cn ite sewage systems must be properly maintained. The septic t;I must he pumped by a [tensed <br /> p.r per whenever necessary, usually every '_ to 3 year, <br /> 6. i` you have questions concerning your onsite sewage system, contact your local code admmistrater or the <br /> State of Wisconsin, Safety & Buildings Division. 608-266-3815 <br /> Tu be complete and accurate this sanitary permit application "lust include. <br /> P'oP 't" ownA 'S name and mailing address r^vl-+.., the legal description and parcel tax number(s� of <br /> Ahe,e the systc,, 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 hox depencling on system type <br /> VI. Absorption system information. Provide all information requested in #1 ? <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 a!/ <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 /> SBD6398(R_11/881 <br />