1994/11/23 - SANITARY - SAN - Other

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INSTRUCTIONS san;tary permit isvalid ror (n.c (2) year. 2 "our sanitary permit may be renewed re?oie tha .-xp;ration date_ s-r. al the time of renewa! any new criteria in the wisconsi Admmistra,:,e coc_ , n he applicab!o. 3 All revisions to this permit must be approved by the permit issuing authority. 4, Changes in ownership or plumber requires a Samtary Perm;t l7ansferlHenewal Form (SBD 9399; to be submitted !o the county pnoi to installation_ Cinsite sewage systems must bn properly maima ted. The sephr, tanks) must he pumped by a lice;ued pur Hu wt;ar�tv�' necessary. os�aj , ewe;} ' t:; 2 years 6. if you have questions concerning your onsite sewage system, c !e ,. 9 1- em, contact your local code administrator or the ts._ <_ ;�lisconsir,. Safety & Buildings Division, 909-26E-3815 To be complete and accurate this sanitary permit application must include: ' Property Owner's name and maihn address Prcwo- the iegal description and parcel tax nurnber(s) „r where the system is to be installed - li. Type of building being served_ Check only one arid complete # of bedruOrns it 1 or 2 Family Dwelling, III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B it permit is for tank replacement, reconnection, or repair. k` Type of system. Check appropriate hox depending on system type VI Absorptio.^, system information_ Provide all information requested VII_ Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for al septic, pump/siphon and holding tanks for this system. Check experimental approval only it tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers, wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system it required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. S130 6398 in 11/88;