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INSTRUCTIONS <br /> F. sanitary permit is vain fu; two T r ears. <br /> lei <br /> Your sanitary permit may be renewed beton- the expiration date, and at the hme of renewal any new <br /> criteria in the Wisconsin Administrative erode %:1 bo applicable. <br /> All revisio^s tc this per;m;*, must be approved by the permit issuing author;'iy. <br /> Changes in ownership or plumber requires a Sanitari, Permit Transfer'fie newal Form (SBD 6399) to be <br /> submitted to the county prior to installation. <br /> 5 e^site sewage systems must be properly mamtainLd. The septic tank(sl must be pumped by a licensed <br /> ,;.' ;pu W,`:eitc 'r.- necessary <br /> 6. <br /> If you have questions concernmg your onsite sewage system, contact your ;ocai 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 /> )perry ou.,ar s name and maij-nq address- Provrda the legal descripnor, and parcel tax number(s) of <br /> n :crc rhe system i t, be instal-ed. <br /> G Type of building being served Check only one and complete # of bedrooms is 1 or 2 Family DweCing- <br /> III. Bu•Iding use. If building type is Public, check all appropriate boxes that apply. <br /> I'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 nn system type. <br /> Vl Absorption system information. Provide all information requested in ##1-7- <br /> `:I; 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 /> 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 Sf� 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 /> SBD-6398. IRA 1/88) <br />