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INSTRUCTIONS <br /> aa�itary permit is valid fcr hvc (2) year,_ <br /> 2 Your sanitary permit may be renewed before the expiration dateand at the time of renewal any new <br /> criteria 1n the Wisconsin Adminlstra;Iw� Coe., be applicable. <br /> u, re:-isions to this petmR must he a,lurovcu u,, t;ie permit isswng authority. <br /> 4 Changes in ownership or plumbe, requires a Sanitary Permit Tra->fertRenewal Form (SBD 6399) to be <br /> submitted tc the county prior D.; I lstalhatw , <br /> Onsite sewage systems must he proD2r!y rra!ntame::. The septic tanklsl must be pumped by a licensed <br /> pu r,p� whe:iCo et iiECCiSa:�. �aua y �v �y o� ,cab. <br /> 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the <br /> State of Wisconsin. Safety & BuJdmgs Division, 699 ?66-3815 <br /> To be complete and accurate this sanitary permit application m�ist include <br /> Property owner's name and rna,hraddress Pr,.Dii the legal description and parrei tax numbers,, of <br /> w`C, '.-_ system is to be installe' <br /> il_ Type of budding being served. Check only one and complete s+ o' becrooms if 1 or 2 "al Dwelling. <br /> III. Budding use. !f building type is Pubuc, check all appropriate boxes tna' 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 dependin , on system type_ <br /> VI Absorption system information- Provide all information requested in #1-7. <br /> VII Tank information Fill in the capacity o4 every new and/or existing tanklist 'he total gallonsnumber of <br /> tanks and manufacturers name. Indicate prefa_/ or site constructed and tank material. Complete for ail <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, eta), 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 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 tanks) 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, R) 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 /> 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-6396(R 11/88) <br /> IA <br />