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INSTRUCTIONS <br /> A samtary permit is valid for two (2) years. <br /> 2 Your sanitary permit may be renewed before the expiration date, ann at the time of renewal any new <br /> criteria in the Wisconsin Adan omstrative Cedo ;:^I! be applicable. <br /> All revisions to this pel!nit must be approved by the permit issuing authority. <br /> 4. Changes in ownership or plur:--,er requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be <br /> submitted to the county prior to installation. <br /> Oncde sewage systems must he properly maintained. The septic tank(s) must be. pumped by a licensed <br /> punier whanever necessary, cSudily eaery 2 tc 0 years. <br /> 11 you have questions concerning your onsite sewage system, contact your local code adrninistra'or o- the <br /> State of Wisconsin, Safety & Buildings Dw,sicn. 608-266-3815 _ <br /> To be complete and accurate this sanitary permit application must include: <br /> 7 Property owners name and mailing address. Provide the legal description and parcel tax number(sl �r <br /> where the system is to be installed. <br /> ll. Type of building being served. Check only one and complete # of bed;ucrns if 1 or 2 Family Dwelling. <br /> Ill_ Building use. !f building type is Public, check all appropriate boxes that apply. <br /> tv. Type of permit. Check only one in line A Complete line B it 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 ?. <br /> Vl! 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 3';/ <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'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 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 /> SBD-6398( 1 11/881 <br />