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INSTRUCTIONS <br /> A sanitary permit is valid for two (2) gears. <br /> 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new <br /> criteria in the Wisconsin Admnnistrattve Code wall be applicable. <br /> A,l revisions to this permit must be approved by the permit issuing authority. <br /> 4 Changes in ownership or plumber requires Sanitary Permit TransferlRenewal Form (SBD 6399) to be <br /> submitted to the county pnor to installation. <br /> Onsite sewage systems must he prooerly maintained. The septic tack(s) must be pumped by a licensed <br /> IWMpc: whanevel riecessary ❑sual;y evr.,y 2 t, 0 yea,,. <br /> r, if you have questions concerning your onsite sewage system, contact your local code administrator or the <br /> Mate of WMsconsin. Safety & Building-- Dw!slon. 609266-3815 <br /> 10 he complete and accurate this sanitary permit application must include'. <br /> Property owners name and mailing address. ProviHe 'he legal description and barrel tax number(s? of <br /> � herc the system .,, to be installed <br /> II Type of ouilding being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. <br /> M Building use. if building type is Public, check all appropriate boxes the` apply. <br /> .V. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or <br /> repair. <br /> Type of system Check appropriate box depending ori system type. <br /> VI. Absorption system information. Provide all information requested in #1-7. <br /> -ill Tank information Fill in the capacity or every new and/or existing tank. list the total gallonsnumber 01 <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 /> 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 /> 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 11/66 <br /> i <br />