1987/03/11 - SANITARY - SAN - Other

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INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years:. 2. Your sanitary per may be ren,wed before the exp ration date. and at the time of renewal any new c,itena In the Wisconsin Admim-trative Code win he. appi,caiile; Al' revis ms to this perm , rt St 'uc ..r ,n,:-�eC , rte e suing authoi tp P rt,v per it may 'f th re is a ch �ge In yctJcLi C-?s , S):.Te.. a,. _?im ated waste,. ater 'I ovd m! rooms, etc.;. depth o! syste,r. o- type of sys+.er• - >> submitted to the county trior t0 :nstallaton rivate .,awagt , as iws. h, re-) ,�, :eL- ' .a' c b- ., _. ^. r.::. t number .r P❑rpuse ri appi ealloi Cne(.K ot,,'.r. one ln. 7/I. ;ont ;lete Sc r ;)ert,f lur [arir ep a::e:hunt, re sur neeilUn [n repair; IV Type of system: check all approp,late boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6. VI- Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be Installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for al/septic, lifUsiphon chamber and holding tanks for this system- Check experimental approval only if tanks received experimental product approval from DILHR, VII- Responsibility statement. Installing plumber Is to fill w name license number with appropriate prefix (e g. MP, otc.). address and phone number- Plumber must sign application form. F;h in designer name if applicable; VIII. Sol! test information. Certified soil testers name ce-t'ficator. nurnbe! ad;', a,id phoce numbe, iX. County/Department Use Only X- Comment area for use by county or resaon giver,. when applicator is disapprove(; Complete plans and specifications not smaller than` t'.5 11 riches must be submitter', to the ;;ou^'y. -he plans must include the following: A) plot plandrawn to scale or with complete dimensionslocati:in o` holding tankfs), septtr, tank(s: or other treatment tanks, building sewers; wells. water rnains/water service streams and lakes: dosing or pumping chambers, dish butior. boxes sort absorption systems. replacement system areas. a.i.,' rhe !ovation cl the bui,chng served. B': hor.zontai aid vertical eievation reference points; C; complete specifications for pumps and controis. dose volume; elevation differences. bicron loss, pump performance curvepUmC r. mode! and pump n.ar I,faco;re . D; cross sectior of the .ol' required by the county, F, soil tes: data on a 115 form. GROUNDWATER SURChARGE - ...