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INSTRUCTIONS
<br /> iamtaiy po,n.w -s vaiirf fpr :v,,,) f2) year-
<br /> Y,-,, i r Sanitary pe: n tr t Al i
<br /> any new
<br /> e .1 1) T- tj p. 1�
<br /> 1, 1-e U?.'r
<br /> t Changes in ow^ershi� requires a
<br /> sa!t:y Df' Irl t
<br /> ssbrnitted to the .-.ounty pf;G, !D 7,„ajj,,L,j
<br /> Orqtt rpwau ., sy_.ter- ust be 11,jleriv — .,tamed -rta,im:� nu he by
<br /> pumper whenever recessn,y, js.jaliy every 2 to 3 year,,,
<br /> 6 If you have questions concerning your onsite sewage system, contact ycu, local code acln,,nistrato , 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 /> 11 Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
<br /> Ill 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 6 it permit is for 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 .3/1
<br /> septic, pump/siphon and holding tanks for this system. Check experimental approval only ;f 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 /> K County/Department Use Only.
<br /> Complete plans and specifications not smaller than 81/ x 11 inches must be submitted to the county The
<br /> plans must include the following Ai plot plan, draws 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, replacements st m
<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;
<br /> 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-6398(R.11/88)
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