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INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT. <br /> APPLICATION <br /> TO THE APPLICANT: <br /> 1. This sanitary permit is valid for two (2) years: <br /> 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new <br /> criteria in the Wisconsin Administrative Code will be applicable. <br /> 3 All revisions to this permit must be approved by the permit issOing authority. A new Hermit may be needed <br /> if there is a change in your building plans. system location, estimated wastewater flow (number of bed- <br /> rooms, etc-)- depth of systernor type of systern; <br /> 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be <br /> submitted to the county prior to installation. <br /> 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed <br /> pumper whenever necessary, usually every 2 to 3 years, <br /> 6. If you have questions concerning your private sewage system, contact your local code administrator o, the <br /> State of Wisconsin. Bureau of Plumbing, 608-266-3815. <br /> To be complete and accurate this sanitary permit application must include. <br /> I. Property owners name and mailing address. Provide the legal description where the system is to be <br /> installed, <br /> II. Type of building or use served If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat <br /> restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; <br /> III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or <br /> repair, <br /> IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project <br /> is in conjunction with University of Wisconsin. <br /> V. Absorption system information: Provide all information requested in #1-6; <br /> VI. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, <br /> number of tanks and manufacturers name. Indicate prefab or site constructed and tank material. Complete <br /> for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if <br /> tanks received experimental product approval from DILHR, <br /> VII. 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. Fill in designer name if <br /> applicable, <br /> VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. <br /> IX. County/Department Use Only; <br /> X. Comment area for use by county or resaon given when application is disapproved. <br /> Complete plans and specifications not smaller than 8'/z x 11 inches must be submitted to the county. The <br /> plans must include the followings 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; dosing or pumping chambers, distribution boxes, soil absorption systems, replacement <br /> system 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. <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------ <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 bill Grouriiater <br /> included the creation of surcharges (fees) for a number of regulated practices which Wisco in'S <br /> can effect groundwater. The surcharge took effect on July 1, 1984 All of the water that buried reasure J� <br /> is used in your building is returned to the groundwater through your soil 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- _t <br /> water, groundwater contamination investigations and establishment of standards. Groundwater, <br /> it's worth protecting. <br /> SBD-6398(R.03/86) <br />