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INSTRUCTIONS <br /> A sanitary permit is valid for iwu r2) years. <br /> Yojr banitary permit rn, he y twee tef_•'e the ex F., a r.t tke rine f renewal anv new <br /> c,tena in the Wisconsin ' fi i;:r c Gode w i' r,e applicabfe� <br /> C, evis,c ns to this perm rout,' , approved by the permit issuing authuniy. <br /> 3 Changes +n nwnersh!r n m ,-=h;ar requires a Sanitary P ,mit T yes+er/Rer.ev/al Fnrm IsBC 6399) to be <br /> sub miffed to the. ;:CSuniv Dr!w tc *istaiiahull <br /> `i. 0,rs'ty sewage systems *st be 7;a!n,ai,^.ed �e �e^P, a:7ios+ mist bePu�'P� �, ed b a licensed <br /> Y <br /> per whenever necessary. asual,y every 2 to 3 years. <br /> 6. It 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 all <br /> septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received <br /> experimental product approval from DIIHR. <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'/ 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 /> SBD-6398(R.11/88) <br />