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INSTRUCTIONS <br /> A. sanitary permit is valid for two (2) years <br /> Your sanitary permit xray Le re ,ewed befcro '7 ; ..xp, t .;arc --,r Ine ..roe _! renewal any neve <br /> cri'ena in the Wisconsin Adr^in°st, r,,e Co r w,i', be appiicabre. <br /> cvs'ons tc inis pri ..st re approved, by the permit ;ss,_ .g authority. <br /> ! Cha.,ne�3 ,r ownership » �!ur^he• requires a 6anrtar•� Porn"? "Qr.sfe• �P-ne•wat rrrm ISBD 6'499 to be <br /> s,At witted to the county pr e: to tstallntion <br /> r Onsite sewage system ust he, properly ma ',ta nvd The sept) . r­(;,T be pumped by a sensed <br /> ;,:;roper whenever necessary, usually every.2 to 3 years. <br /> 6 If you have questions concerrmg ,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 jill <br /> VII. Tank information. Fill in the capac,ty 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 DILHR. <br /> Vlll. 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'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. <br /> ---------------------------------------------------------------------------------------------------------------------------------------------- <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-6396 t R.t 1/88) <br />