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INSTRUCTIONS
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<br /> .r •;smtary per-,' r,ay t,r re�cr, r . xp,ration date, enc at the time of renewal any new
<br /> u;Tcr'o Niscons,i- nt'r m",*i-awivo :,:x applicable.
<br /> pa:r,,;t ,sl. t-c ,pare+e-, tfre per-ut ss' fig authority.
<br /> r lw-t r, ...nr_ c tir „ = ,.;.,,y- ��r.r.,. T-a r'Ranawar Form rtiFlU �,3eg1 to be
<br /> t ,1 for -i cc! nb- on r to ,arr....
<br /> ,y
<br /> p
<br /> ..,. - _ _ ., „�_ e� -i-rt;- . . -; mfrs* he umee.. dy a Iroensed
<br /> ..ng : e E ..r cor*a year Inca) case adm,n,,'rn *.hc
<br /> -,r ,.__- ;sin, Sah.,,
<br /> .::t applwauor ,. ncl-,rde
<br /> name; a r a,!in J hee,jiay de,c,-fi ion and parcel tax numberisr r`f
<br /> Tyl-e of Gdnor„g being served_ Cherre, only are .md curnG ,.:r !, cf s_J ;;ems if :am, ', Dwel; ray.
<br /> .11. P„, 7rng se. a nodding 'ypie ,s Pub! c, check all appropriate boxes that apoly
<br /> Type of permit. Check oniv occ: „i we A_ complete fine B if permit Is for tank replacement, reconnection, or
<br /> repair
<br /> `ypze cf system. Check appro,, late b , do, rich y -, :,stem type
<br /> gy sl2minform atrt`n Prov r :I! °r-`-rro .'ir`n requested in P! 7
<br /> `a,rk =iti ;n U F rprr(. p rc,,v , e;zistmg tarp :i,,t the total gallons, ^umb--!
<br /> Tanks anC Warne. lucrc�te I it, ,r site constructed and tank material. Cornp„ to "[',r all
<br /> septic, purnp/siphon and hold ng tank r.. a,,,_ Check experir-enfa; approval only f tanks received
<br /> experimental product approval from DILHP..
<br /> Vill. Responsibility statement. Inc^takirg plumber is to f!❑ !n name, license number with appropriate prefix (e.g.
<br /> MP, etc.), address and phone number. ?lumber 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'h 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.
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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 con'ram„ration investigations and establishment of standards.
<br /> i_:-8391 iii.?!/gi_
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