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INSTRUCTIONS <br /> i A sanllary perp„t is valid for two 2) years <br /> _. Y�.ir sanitary permit ire tie re-,c wa_,1 here cr jafr_ a 1; •z e any new <br /> crsteria 1n the W,scors i A dn,,n,s :t ve Code w ',e u ,nplicabls. <br /> 3. t.l PVi S�qn$ ”' = pp, n n U81 ��i OVe b4 t.'7c 'r(1.. :SSGr.g nUtllprlty. <br /> G Changes in ownership rIcmher requires - S tr..ti_ry oer,nu rr, r­ferlRrnewal Form iSPD 83991 rc be <br /> s,11,mitte.d to the county prior tc Installation. <br /> 5 Onsite sewage systerrs ntainad. The se rtr• tanBis' mst be urn e h <br /> -p. p p c. _y a :icensec <br /> ,n,mper whereser necessary, ,:suafy every 2 to 3 years. <br /> 6 If you have questions concerning your onsite sewage system, coetact 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 <br /> I. Property owner's name and mailing address. Provide 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 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 an,d/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 /> SBD-6398(R.11/88) <br />