Laserfiche WebLink
INSTRUCTIONS <br /> y pl, friir ,n "I d w; rwG (2, yaar— <br /> Your sanitary permit may De renewed before the rxp!ration date, acid at the time of renewal any new <br /> criteria in the Wrscons!n Administrative Cod^ .vl!! be apphcab!e. <br /> to this pe(mi: mast be approved b; the patmit issuing ,luthorty- <br /> 4.. Changes in ownership or plumber requires a Sanitary Permit Transfar!Renewai Form (SBD 63391 to lie <br /> submitted to the county prior to installation. <br /> 5 Ons,fe sewage System , MUM tie pro pe-;y ma .tamad. The septi, to^x,sl must be pumped 5y a licensed <br /> f:u whe�,;var necerary, suai,y eveip 2 to 3 guar - <br /> 6. If you have questions concerning your onsite 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 nwst include. <br /> Property owner's name and mailing irfdress Pr viae she legal descnp,,on and parcel tax nurnber(s! -t <br /> where the system Is to be installed. <br /> Type of ouilding being served- Check only one arid corn,jio:,+ # of v soros i' 1 or 2 'amic Dwel:iilg. <br /> III Building use. It building type is Public, check all appropriate boxes that apply. <br /> IV 1"ype of permit. Check only one in line A. Complete line B it permit is for tank replacement, reconnection, or <br /> repair. <br /> Type of >ystern. Check appropriate hox depending on .ystem type <br /> V!. Absorption system information. Provide all information requested in #1-'. <br /> vii Tank ;information. Fill in the capacity o4 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 a// <br /> septic, pump/siphon and holding tanks for this syster,;. Check experimental approval only if tanks received <br /> experimental product approval from DILFIR. <br /> VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix le.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 W6 x 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 /> 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. <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------- <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-5398(R_11/f <br />