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INSTRUCTIONS <br /> ?. A sanitary permit is valid for two (2) years. <br /> Your sanitary permit m ay be re...e,we(; he?fo c ;'�e sx,^- _ . ,,ate 3 rpt rr)e time c' renewal any new <br /> criteria in the 14isconsin Admm,rt .?Ave Co,le III iIi appucat/ie. <br /> 3 A. E\,sl( e, tc this pt r r q mus' e. a.)6 i�.:ved by ilea pam,j issuing acthority. <br /> 4 Changes •:n ownership rr m, he egcires a Sa^. ta",• germ•,' F.^: !SRC) 6399_` .c be <br /> submitted to the county Drier to • s 1Paten. <br /> pnsite sewage system .•yet t� nrcpr,'v ^ nta;':ed T11-p ne;r^ •nnki,, ._ Dumped by !kensed <br /> pumper whenever necessary, usually every 2 to 3 vears. <br /> 6. If you have questions corcer ning 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 numbers) of <br /> where the system is to be installed. <br /> 11. 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. 'ist 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 systerm. 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. Plwmber must sign application form. <br /> IX. County/Department Use Only. <br /> X. County/Department Use Only. <br /> Complete plans and specifications not smaller than 8Yz -, 11 inches must be submitted to the county. The <br /> plans must include the following. A) plot pian, 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 />