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INSTRUCTIONS <br /> A sanitary permit is valid for two (2) years. <br /> . . Your sanitary permit may t;e renewed before the ,x< d< i <br /> ,itF "n" at f =me :;' renewal any new <br /> criteria in the Wisconsin o.,im,r strrarve Code will be applicable_ <br /> Ai' evislnns to this per nm!s' hP apprcved by the permit issuing authority. <br /> a Changes in ownership or p smger requires a San,tary ver^ [+. T �s'r,'nenev, .i Fn= 'SBn 6399' tc be <br /> submitted to the county prior tc installation. , <br /> F- Onsite sewage systems must he i openly ma ntairled 7"c saps- nkfc� m-,t tie pumped by a '.icensed <br /> pcmper whenever necessary, usually every 2 to 3 years. <br /> 6 If you have questions concerning your onsite sewage system, contact your !oca! 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 #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 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 's 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 814 , 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 /> 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 />