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- . .. - V ty. <br /> ,. <br /> �; .un- <br /> :g <br /> �)e• bvhl nt1".r nP,(".S .. 'J°il , �lAf:ry �. e7" , <br /> y <br /> J l a4e y4t ,'bn9 ..O n�C r r,;ng y sur nsl,e Sewage Sirm, :..n�a.,i j.,Jr :_r a: cod ad,-dtlst x or C- -. c <br /> State of Wisccn,s;n, Safetv 8 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. Provic"e the legal description and parcel tax number(s) 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 6 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 o1 every new and/or existing tank., 'i st the total gallons, number of, <br /> tanks and manufacturer's name. Indicate pre"ab or site constructed and tank material. Complete for all <br /> septic, pump/siphon and holding tanks for this system. Check experimental approval only '.f 'anks received <br /> experimental product approval from Dli a <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 8Y, ,: 11 inches must be submitted to the county. The <br /> plans must include the following: Al plot pian, draw:: io scale or with complete dimensions, location of <br /> holding tank(s), septic tank(s) or other treatment tanks, bcildirg sewers wells, water mains/water service, <br /> streams and lakes, pump or siphon tanks., distribution hexessoil absorption systems, replacement system <br /> areas, and the location Ot the building served. B) hori/,-Mal and verl,ral s!evation 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, 01 cross section of the soil absorption system if <br /> required by the county, EI soil test data on a 115 form, and F) all sizing information. 11` <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 nontamination investigations and establishment of standards <br /> SBD-6338 118.11!88) <br />