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.I.e <br /> ass a iy. <br /> a .-.,nit;81 <br /> ill OF, ovol nec Os S sry. ',is uai1', evef y ? ic, 3 years. f <br /> it rcu have qussfions ..once ring your cri,ite sewage �,-1 �7, o,.,tact yo, r :real ccdc adn;aa ., c _. ttw <br /> State of Wisconsin, Safety & Buildings Division, 608-266-3815 <br /> To be complete anrd accw(ate this sanitary permit application must include: <br /> Property owner's name and mailing address P,,ovide 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 /> VL'. Tank information. Fill in the capacity of every new and/ar existing tank, list the total gallons, number of <br /> tanks and manufacturer's name. Indicate prefa� or site constructed and tank material. Cbmplete for all <br /> septic. pump,s_iphcf, and holding tanks for ihiF system Check expert n•ental approval only it anks receiveo <br /> experimental product approval from DILHR. <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% * 11 inches must be submitted to the county. The <br /> plans must include the following A) plot pian, drawn to scale or with c,mpiete dimensions, location of <br /> holding tank(s), septic tank(s) or other treatment tanksbuilding sewers: wells, water mains/water service. <br /> streams and lakes; pump or siphon tanks; d,stribution boxes: scil absorption systems; replacement system <br /> areassand the location of the building served; B) horizontai and verticaelevation 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 /> GROUNEY'll ER 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 /> 1 <br /> SBD-5398 (R.11/88) <br />