1995/05/09 - SANITARY - SAN - Other

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INSTRUCTIONS R sanitary permit is valid for t,eIo (2) years. Your sanitary permit may be renewed before the expiration care, and at the time of renewal any new criteria in the Wisconsin Ad.,m=trative Code will be applicable. 'i All ravisons to this permit must be approved by the permit Issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfe, fienewal Form (SBD 63991 to be submitted to the county prior to installation. Or^s 'e sewage systems most he propedv maintainc- ! The naptic ta^. s) must be pumped by a licensed pwi,,u; rvheiiu.ei nece sarye<e:y 2 fes. 3 year, 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the S—te of 'Wisconsin, Safety 8 Buildings Division 69&266-3815- be complete and accurate this sanitary permit application must include. Property ^anars name and mailirg address Frevide the !Aga; desarh�<,.on and parcel tax numher(sr vrhera the System is to be ,stalled. II. Type of building being served Check only one and compieto IT of hedoon,s it 1 or 2 Family, Dwelling-, III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B it permit is ror tank replacement, reconnection, or repair. V Type w system. Check appropriate box depending or, system type- V! Absorption system information. Provide all information requested in #1-7. '�'lI 7ank information. Fill in the capacity or every new and,or existing tank, list the total gallons, number of tanks and manufacturers name. indicate prefab or site constructed anc tank material. Complete for all _ septic. pump/siphon and holding tanks for 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 8% 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,11/88)