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INSTRUCTIONS <br /> 1. R ,anitary permit is valid for two (2) years. <br /> 1_. "uur san!ta'. perrnit '')Iy ;;e '.' Fri„u :`rr.°” v '� E :: , ,- r _, hr ., ee <br /> .e c , wal any rew <br /> � iteria in the Wiscor r Idmo !•;.r,e C; n <br /> rte- H be apH .au.�e. <br /> L revlsKons to --r>s iv -, y the permit autiiorty. <br /> Cha nge, Ir cwr9rshlr, 7, „mh recut reg a San lta , Prr;+ ' s`er-Pa Bwa! Fn,? :jBr) n'990 'C be <br /> schntirted to the ccu^t} ,,r c. to .ataliatiori <br /> 6. Onsite sewage systems nl,isi be p-r .?r' m ..,aired r*.e sePtl ..x„1) _t be pumped by a licensed <br /> p.;mper whenever necessary. .sually, every 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 R 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 /> il. 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 a!I 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 'Lank material. Complete for al/ <br /> septic, pumpisiphon and holding tanks for this system. Check experimental approval only if tanks received <br /> experimental product approval from DILHR. <br /> Vltl. 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 8X < 11 inches must be submitted to the county. The <br /> plans must include the following A) plot plan, drawn to scale or with complete dimensionslocation 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 />