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INSTRUCTIONS <br /> A sanitary permit I� va:id for two (2; yaaro. <br /> 2. Your sanitaryPermit m <br /> p may be renewed before the expiration date- anr, at the time of renewal any new <br /> criteria in the Wiscons!r. Adm,n!strat;,c CodeA, :e applicable. <br /> % ' islons to thise,r t., rn <br /> P ust Ge approve ,y ;he Pcfnjit issui ig authority. <br /> 4. Changes in ownership or plumber requires a Sanitary Perri Transtar'Renewal Form (SBD 5339; to oe <br /> submitted to the county prior to installation. <br /> 5 Ons to sewage systems must b'n prr�^-ly ma,mtair,ad. The septic tari,is; must be pumped 5y a licensed <br /> Pu vc" where ei neces,ajy. .,,,a y yr,drs_ <br /> 6. If you nave questions concerning your onsite sewage system, contact your local code administrator or the <br /> State Of Wisconsin, Safety & Buildings Di,,ision, 608-�66-3815 _ <br /> `o be complete and accurate this sanitary permit application must include. <br /> Property owner's name and mailing ncidressF. e the i, <br /> '9a <br /> where tre s cm is to be installed. - descnpnnn and parr_el tax nu nher(< t <br /> � � <br /> Ys. <br /> G Type of building being served. CnecK only one and comp ! h of oc - <br /> III, Building use. If building type is Public, check all a or a' ! %'^ <br /> 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 /> V! Absorption system information. Provide all information requested in #1-7 <br /> VII Tank information. Fill in the capacity o' every new and/or existing tank, ii.st 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 systen;. Check experimental approval only i1 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 8Yz x ll 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 11!5 form; 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- <br /> water contamination investigations and establishment of standards. <br /> SBD-6398(R.11/88) <br />