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INSTRUCTIONS <br /> 1. A sanitary permit is valid fur two (2) years. <br /> Y ur ;aritaTy pe•m:t 5e renc Nr,i !'WOW ii,k r-, date :c." ,-rt the I me •,f renewal any new <br /> :A ter-a :r the Wiscnr. i;,, �:t .e Gnc e w ' .,e appIICable. <br /> A s:r.r• is th s pen. f !)e a pr, ved by the permit issuing autnority. <br /> ? Charges + ownership -`_rmber ;equires a Sanitarp Tr ,nsferiRenewal Grrrn (SBD 63991 to be <br /> sunn-,i:te' to the county prlcr to nstallatior. <br /> Crsm, sewage systerns -..st b, p--re-ly rr,1intalr�ed `he sept ank(s'� musi be pumped by a licensed <br /> dumper whenever necessa:�,-. ,Isually every 2 to 3 years. <br /> 6 if you have questions concerning your onsite sewage system, contact your !oval 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 /> L 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 /> il. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. <br /> Ill. 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 o1 every new and/or existing tanklist the total gallons, number of <br /> tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a// <br /> septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received <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 81/ 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; 8) 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-6396(R.11/88) <br />