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INSTRUCTIONS <br /> 2. Your sanitary permit may be renewed before the 9zplravon date, and at the time of renewal any new <br /> criteria in the Wisconsic Ad-nm:stra^ve reC_ _� app!;cab'c- <br /> Af rLvislons to this permit must be appm.rou c; t;ie perrnrt isdui�g authority. <br /> 'l. in ownership or pl, -nber requires a Sanitary Permit Transter/Renewal Form (SBD 6399) !o be <br /> submitted to the county pr:o� to installat,or <br /> 5 Onsite sewage. systems mus? he o-op-rly ma nta�ocd. `fe septic Tank!sl m is! he pumped by a r.,., <br /> puri per Nh, .n -,eec.ssz , Tsui ly evsy year> _ <br /> 6 if you have questions concerning your onsite sewage, system, contact your local code administrate, or the <br /> State of Wisconsn, Safety 8 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 Prov,,,- the legal deScrjp4on and parcel tar orrnber(st of <br /> where the system is to be installed. <br /> iI. Type of building being served- Check only one and complete m et bed:Cof119 if 1 or 2 'ami!,, Dwel;,g- <br /> II1. Budding use. If building type is Public, check all appropriate boxes tha! 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 �j,i system type- <br /> VI Absorption sys!em information. Provide af mformati;,n requested m #1 <br /> 'all Tank information. Fill in the uapaciiy e1 every new andior existing tants, list the total gallons, number of <br /> tanks and manufacturer's name. Indicate prefab or site constructed and tank material, Complete for ali <br /> septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received <br /> experimental product approval from DILFiR. <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. 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% 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 /> SSD-5398 IR.11/88) <br />