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INSTRUCTIONS • • • 4 . 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399)to be _Sibmitted to the county prior.to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety& Buildings Division, 608-266-3815. _To be complete,and accurate this eanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of • where the system is to be installed. • II. Type of building being served. Check only one and complete#of bedrooms if 1 or 2 Family Dwelling. III. Building use. If buildi4type is Public, check all appropriate boxes that apply. IV. Il pe of p' rnifr,Gt,eck only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system Information. Provide all information requested in#1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gations, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Gdmplete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received perimental product approval from DILHR. VVa�l esponsibility s{ tement.-Installing plumber is to fill in name, license number with appropriate prefix (e.g. JI}" MP, etc.), adittas and phone number. Plumber must sign application form. 6VX. CoUrity/De*relent Use Only. X.,�Counryy, - °ment Use Only. Coai4plans and specifications not smaller than 8% x 11 inches must be submitted to the county.The ust include the following: A) plot plan, drawn to scale or with complete dimensions, location of A ing tank(s), septic tank(s) or other treatment tanks; building sewers;wells; water mains/water service; creams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences;friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E)SOif test data on a115-form; and F)all sizing information.. GROUNDWATER SURCHARGE '"`iii°'r"o 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. • • SBD-6398(R.11/88)