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INSTRUCTIONS t. ^, .3anitaly permit ,s va!;o for . i2; year- 2 Your san,tary permit may oe renewed oe,ore the _,xplration date, and at the lime of renewal any new criteria in the Wisconsin Admin!strn!!ve Code w!!! be applicable. All revise.ons to this permit mus! be approved by ttie permit issuing authority. 't „hanges in owners ;p or plumber requ!ras a Sanitary Permit Transfer'Renewal Form ;SBD 8399) to be subs'nitted to the county prier to i ,stakat;nn Ursite sewage systems mi sf he r), ly rra!n a;ne' The sept-c tank(sl mus' he pumped by a licensed pus."..Ho �a =ili:be fleGess J"o Af, _-vFiS _ _- "a H " you have questions concerting your onsite sewage system, contact your local code administrator or the F`-h'-e of kA!s^nns!n. Safety R B f !ding rY s!or' 60r8 :16,3815 To i>e complete and accurate this sanitary permit application must include: O'opertj od!ner'c name and na !m,J acfres• "rovi�e he i-gal dPsrrh[inn and parcel tax grmberfck rd where the system •s t-I be Insta!led. !i Type of building being served. Check only one and complete # of bedrooms if 1 or 2 �amny Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. Ib. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. Type of system. Check appropriate box deoerlumu n, ,ystem type- Vi A.bsorprion system information. Provide al! informatioh requested in #1-7. -T -,ank -eformation. Fili in the capacity .:i eve:y new and/or existing tank, Dist the total gallons, number or tanks and manufacturer's name. Indicate pretab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks fcr 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 81/� 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 tank(s) 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(R.1 V88)