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INSTRUCTIONS
<br /> sanitary s valid nAc, i"': years
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<br /> .S,hr itt--A to the ::runty pr6r to yrstaIlaticn
<br /> 1) orsite Sew,,ige S}Slerrrs mist be rr'i[pe"Iy rinan-taip"'d he septs, must be pumped by a licensed
<br /> pumper whenever necessa,?, usually e,,e:y 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 /> L 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 /> IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
<br /> 111. 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 all
<br /> septic, pump/siphon and holding tanks for 'his systern 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"' , 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 tanks) 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, 13) 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.
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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(8A1/88)
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