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INFORMATION & INSTRUCTIONS FOR COMPLETING A S>s W sArw PERMIT
<br /> APPLICATION
<br /> TO THE APPLICANT:
<br /> 1 This sanitary permit is valid for two 12) years:
<br /> 2. Voor sanitary permit may be reneveed before the expii atinn dote. and at u%k- Imp of !-P, wa! am, neo/
<br /> cr,terla in the ,Ni ,:opsin Adminisr,alive Code will be app xahle
<br /> 3. All revisions to this permit nwst br appr.-,ved I/y upR,
<br /> if there is a change in your build❑rr ant. ; „ieni �.c)I 'iirrt ,...r. riow inur:rba:* , h xi
<br /> ,
<br /> ;oc;n' etc l. 'r.ptr �' sd„te r.. or of =.ys*e rt
<br /> 4. Char res in owner :-,p ,;r , smhc� a . ;•r Ft j, -
<br /> s;bm.fed to'the cuurity T�,ur tolir t 'ahor
<br /> ti- Private sewage sy,t-m`: . rn,.f-hn r;,,Porl,, n�; nt= nNd
<br /> hf -r-rd ,. i_r.al.-. .rr.. .irl
<br /> pumper wt),, ovr r nrza,a a ;aua �� .wr.. „ r, '; ye2
<br /> 6 Ifycw Lives{/. ;t1Ooscur Dbr p...vd te. ,?w ,moi r.a s, r ' _od:. rur,
<br /> State of Wisconsin, Bureau of Plumbing, 608?66-381 5
<br /> To be complete and accurate this sanitary perrna application mus: incl,:de
<br /> I- Property owner s name and mailing addres,. r!ovide the regal do: r 'iii: w r c tine -,y+tis to be
<br /> installed.
<br /> II. Type of hudrirg or use served If puhlia is rrhr ked lype r t r e, 17 r:ri! spar :;r 0 s,>at
<br /> restaurant, etc I. Fill in number of bedroom- if rel+ir•,g i.� a ore or two Tmilr- owe'I,nq-
<br /> III. Purpose r_,1 application C eel: only ie in /it rtmplete == it perm t rel n r arsment r�cnn �r,or, r,
<br /> repair.
<br /> IV Type f dysien check aI /ppr r,f/r r. uoae ;+opi, !,:�g -,siem iyp;- ne(k - .pori manidl r..ly if project
<br /> is in conjunction wltr (in�veisity of P✓ sconan,
<br /> Abs, pt!on system nlc,rrr r' 'w R,- e a!I Irr ite
<br /> v .;nk i'forr,ai, r r '. :n ir`e apt!-:re , eelY rr w ,r F s - .st i! f :'
<br /> numboi of lank, and mar r.rn- hirer' ^:rne iod�r, N f,re'n. pr ,/1:•. .r,-'u r tank m ttr �r ,rpl.•r�.
<br /> for il/septic, lift/siphon utldu.bw a,id holding tanks lug thl systcro u;r „rl nerta ppru,”: -,;I'y if
<br /> tanks received oxpermwntat pro tluc app:ovar! htroni _)IIfir,
<br /> ;IResponsibility statement stalllr,g r ,rutile, s to lul v� oar r c��r. ire/ r. •' a;r, r pn ;�re•1. ;ey
<br /> applicable et l address and phone number. P,umber mist sign applicahcn torr^ Fih, in des,g-er name if
<br /> app
<br /> VIII. Soil test information. Certified soil tester's narne. certiflcaton numbe u;d/erssrd pf.one number
<br /> IX. County/Department Use Only:.
<br /> X. Comment area for use by county of ros,icn gr,/Or when epf-Iif-ation is ;sapproved
<br /> Complele plaar and speclf ;etionI ':of sr, r!ler than 6'✓ n( r !-:r I)e ,61h,n Vert to ttu county. TF.-�
<br /> Plain must iodL de: the fr, !ewmg: A plot plan;. drawn foe Jn ..n wi- comPI.1, ll , ension '.reaLa, of
<br /> hold rig tanks; .,�pt,�, I,ir,c s; ), oT` e realm^.P r L rg ;r:.•c tierrna -vw.,ren ';crvice
<br /> streal.rs and lake dnsln,I pump ng chambr . r+ .,..,h t rn boxe :tics p on sy- -r rAcl ^emr
<br /> sys'.eir areas. ar t tna io<ah ;n :rf tLe b,(;Iding tee :. ver'1, i_—vatlon efe r,,ore pr rt .
<br /> C) complete spec-fir ations for pumps and controls, dove vr 'ume� elevation differences, friction loss: pump
<br /> performance curve, pump model and pump manufacturer, D) cross section of the soil absorption systern if
<br /> required by the county, E) soil test data on a 115 form.
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<br /> GROUNDWATER SURCHARGE
<br /> On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more -
<br /> commonly known as the groundwater protection law. This change in statutes was the
<br /> result of over 2 years of steady negotiation and public debate The groundwater but ,(`7,oundwatBr -
<br /> included the creation of >urcha ge (foes) for a number ' it:qula!ed prae t ces which Wisco R$irt's i
<br /> can effect groundwater- The su chafge took effect on Jury 1, 1981 All of nllo mater that buried kteasure
<br /> is used in your building Is returned to the groundwater through your ;;oil absorption
<br /> system or the disposal site used by your holding tank pumper. ;
<br /> The monies collected through these surcharges are credited to the groundwater fund adminis-
<br /> tered by the Department of Natural Resources. These funds are used for monitoring ground-
<br /> water. groundwater contamination investigations and establishment of standards. Groundwater,
<br /> it's worth protecting-
<br /> SBD-6398(R.03/86)
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