1994/08/10 - SANITARY - SAN - Other

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INSTRUCTIONS A sanitary permit is valid for two (2) years. 2 Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Codc will 3c applicable. 3. All revisions to this permit must be approved by t,-,e permit issuing authority. It Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. n Onsite sewage systems must be properly mainteired- The septic tars(s) must be pumped by a licensed Nun,N�. wY:ai �.ai necessary, ;s,sa ly eery 2 :, : years h. if you have questions concerning your onsite sewege system, contact your local code administra'or o, the State of'Wisconsin, Safety & Buildings Divisiort 6, 3815 Fn be complete and accurate this sanitary permit application must include: I. Property owners name and mailing address. Prove le the legal description and parcel tax number(s) of where !ht system is to be installed. II_ Type of building being serveu. Check only one and rornpiefe 4 of bedrooms if 1 or 2 Family Dwellmy_ Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete une B it permit is for tank replacement, reconnection, or repair. V Type of system. Check appropriate box depending cr; system type. VI Absorption system information. Provide all mformat -�r requested in ##1.7. VII_ Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a// septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tanks) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas, and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 in 11/88)