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INSTRUCTIONS <br /> 1_ A sanitary permit, is vaLd fc^ two (2) years. <br /> _. Yo,.- camta y permit iy I e _ro-�n ec' befit r 1 e p ; ce date ., .r. ;fie ' me o' renewal any new <br /> c =.eria in the Wiscons ­n-nisr-a'�o(, Cod, be applicable <br /> porn ;e npprrved by the peimi: !ss.�mg aaVw)rity. <br /> Crit qes : vrers^i+. r ,.m`••� eq,rres a Sa .,u. r�rmi' T• ^sten"?ene.aal Fr,m ic6n 6299 to be <br /> suL dted to she eun,;y prior to rstaltatlor <br /> D^s'„ sewage system ..;St ne nrocer!y r -iced TIP sep+i,� must be pumped t,y a ,consed <br /> pumper whenever necessary, usually eery 2 to 3 years. <br /> 5 It ,vow.: have questions concerning your onsite sewage system, contact 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. 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 /> Il. 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 /> V!. Absorption system information. Provide all information requested in #1-7 <br /> VII. 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 all <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.q. <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 8,5 -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 /> 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 />