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INSTRUCTIONS
<br /> 1. A samtar,, PeTro.t is valid far two (2) years
<br /> , ,
<br /> Gi.r �ar,eza,y fie r m I i� -'Ye (If,-,�i_ T ;
<br /> any new
<br /> w
<br /> ,ter,a in the
<br /> Ail ,eV,s,enS to PC-f a; p,^,,;id tt� the pet m., ,sb, ing autriuf,ty.
<br /> 4. Charges , -w n e,s 1);r n! I- r requines a Sa n ta-7 DP T'9,'R Pr,ewal F^- SRD 8399? 'c, be
<br /> Sot mltiec to lle ":vurltv prior tc llstailatioW
<br /> C'SN:i sewage syste7rs 1at be nrcperiv ma-ntn,: eci TSF sei- he. pcmped by a
<br /> pi,,nlper whenever necessary, utsi;aty every 2 to 3 years.
<br /> E. If you have qilest!orls
<br /> --cricernma your criSlte 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 /> L Type of building being served Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
<br /> 111. 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 it permit is for tank replacement, reconnection, or
<br /> repair.
<br /> V. Type of system. Check appropriate box depending or 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 arid/o7 existing tank. list the total gallons, number of
<br /> tanks and manufacturer's name. Indicate prefab or site constructed and tank material Complete for Fill
<br /> septic, pump/siphon and holding tanks for this system Check experimental approval only if tanks received
<br /> experimental product approval from DILHR
<br /> Vill 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 thar 81/ 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 /> s!reams 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-6396(R.11/66)
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