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1993/07/27 - SANITARY - SAN - Other
Burnett-County
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TOWN OF LAFOLLETTE
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10080
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1993/07/27 - SANITARY - SAN - Other
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Last modified
3/5/2020 11:07:40 PM
Creation date
9/28/2017 2:38:37 AM
Metadata
Fields
Template:
Property Files v2
Document Date
6/9/2008
Document Type 1
SANITARY
Document Type 2
SAN
Document Type 3
Other
Tax ID
10080
Pin Number
07-014-2-38-15-30-4 01-000-013000
Legacy Pin
014223003500
Municipality
TOWN OF LAFOLLETTE
Owner Name
MELVIN E & SUSAN A DOFFING
Property Address
5441 COUNTY RD B
City
FREDERIC
State
WI
Zip
54837
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INSTRUCTIONS <br /> �. A sanitary permit is vapid for two (2) years- <br /> .-. 'rumor ar'tary par m'.t h,e •c, cwe., , 4u?:r i ,.r:,,.r i2!� &j i' the :ir sl an, rew <br /> c!!?er a !n. the '1P's(.?ns n Fn nstrttt ve Ccde ,.:'i be applicable. <br /> =,!I revisions to this permit rnus; be approvsd ry llre permit issuing authority. <br /> Cl im,es in ownersh;p or plumber requires a Sanitary Perm!t Tra❑sfer/Renewal Form (SBD 6399) to be <br /> submitted to tha county prior to installation. <br /> Onsite sewage systems must be properly maintained. The septic tanks) must be pumped by a licensed <br /> pumper whenever necessary, usually every 2 to 3 years. <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 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 /> II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. <br /> III. 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 B if 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 al/ <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'f. 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 /> 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 /> SBD6398(R.11 M) <br />
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