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INSTRUCTIONS
<br /> 4 sanitary pi is valid for two (2) years,
<br /> yutir SaMtarY PeWllt may he -i before the 11JJTi,1 Ar r at the time c; renewal any new
<br /> :r4e,ta to the Wisconsin C,,(,,Ip be appl,caoic.
<br /> A', pt:)r,;j r),iv' t APPvz,'d by the i ,ssujr.g authority.
<br /> Charges r owmr.qhir or ' 7
<br /> -1 m,-r, require, a Sarna*, r1--1 Trans`,-'Pencv,,a! Form �,Srll 6390, 'o be
<br /> sup mitted to the rcuniv pr,o, to nslaiiauon
<br /> h qnsite sewage systems rnuET t)r 7`-L se-'- �nnl, 7 -�t be p.-miped 'z�y a li-_C-7�sec
<br /> pumper whenever recessary, every 2 to 3 years
<br /> 6 if you have questions concerning your onsite sewage systenn, contact your local code adm,n-istratcr or rhe
<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 /> 11 Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
<br /> 111. Building use. It 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 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.g
<br /> MP. etc ), address and phone number Plumber mus! sign application form
<br /> IX. County/Department Use Only.
<br /> X. County/Department Use Only.
<br /> Complete plans and specifications not smaller than 874 ', 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 servicei
<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,
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<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.11/68)
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