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,. <br /> _ _ uta r2W <br /> 'F•i3 in 1 ,u dJ , _� c,e aFN i�au.e_ <br /> Nbii6, las, n , oui101',iy, <br /> cs Si i ..er r ,e�c.nJ 21 c._, r.n . 7'� iJ `J6 <br /> r `t'Fdl iCCf", f.Pi <br /> e DCm,P - <br /> q. riper wher.eve r recess u.un y eti;�ty t,, years <br /> If yo,, have ques!ions concerning your ans'tu sewage sy.s"em, contact your '.ocal code admn st ' ..:r 7, rhe <br /> State of Wisconsin, Safety & Buiiorngs Div,*on, 608-266-3815. <br /> To be co(npletg,and gcpurate this sanitary,permit application must include' <br /> I. Property owner's name and mailing address. Provide the legal description and parcel tax numbers) of <br /> where the system is to be installed. <br /> If Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. <br /> II!. 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 0 if permit is 'or 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 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% -< 11 inches must be submitted to the county. The <br /> plans must include the following: A) plot plan, drawn to scale or with ccmplete 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; distributor. boxes; soil absorption systems; replacement system <br /> areas; and the location of the building served; Bl 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'`f6rm; 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- 1 , <br /> water co6tamination investigations and establishment of standards. <br /> SBD-6398(R.11/88) <br />