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INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT- <br /> APPLICATION <br /> TO THE APPLICANT: <br /> 1. This sanitary permit is valid for two (2) years. <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 Administrative Code will be applicab'e. <br /> Al' revisions to this perm-t must be approved by i to ;,e.. —s::ing authority A re.v permit may b n::uded <br /> ' thbrc ;s a change ou '>I iIC:.> cars e," ior.aP r r <ti , t <br /> 9 �' Y 9 , SY--' n atcr` waste%�ater low (number cf be,' <br /> ooms. etc.j, depth of system, or type of system <br /> 3W'1 ,,I; O: pl'„ '1J,- R, -,i: -. : <br /> `tet D 6',9Gi if f . <br /> submitted to the county p -cr to o=tallat,or. <br /> F= a u sewage s ;stems ;ust b,, prcoe be pumpod t;y a ce ..,,,u <br /> oalnper rJhenerer n,-ces,a -. ve-�- <br /> Slitc ✓I/isJ!];'. I ire ”' 0r,-� <br /> esta ,I , _. �, c unr n Dr ri^ts Idinc .s a oi( or two family 1we� ing. <br /> _- Purpose of application. Che,,, onl; in 41. ;on „,!ete #2 i' permit Is for tank repiacement, recon gccncn o' <br /> repair, <br /> IV- Type of systems check all appropf lase boxes depending on system type. Check experimental only if project <br /> is in conjunction with University of Wisconsin, <br /> V. Absorption system information: Provide all information requested in #1-6; <br /> VI. Tank information. Fill in the capa-fly of every new and/or existing tank, list the total gallons to be installed, <br /> number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete <br /> for a//septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only it <br /> tanks received experimental product approval from D!LHR, <br /> VII. Responsibility statement Installing plumber is to fill in namelicense number with appropriate prefix (e.g. <br /> MP, etc.), address and phone number- Plumber must sign application form. Fill In designer name if <br /> applicable; <br /> V11! Soil test information Certified soi; tester's name ce-lification numberaddress, and phone ncrnber <br /> IX. County/Department Use Only. <br /> X- Comment area for use by county or resaon given whe,. application is disapproved <br /> Complete pians and specifications not smaller than °'_ - 11 .inches must be submitted to the (.ounty. The <br /> plans must include the following: A) plot plandrawn to scale or with complete dimensions. location of <br /> holding tank(s). septic tank(si or other treatment tanksbuilding sewers. wells; water mains/water service <br /> streams and lakes, dosing or pumping chambers distribution boxes; soil absorption systems_ replacement <br /> system areas:. and the location or 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 Dump manofacturer, D; cross section of the soi:' absorption system <br /> required by the county:. EI soil test data on a 115 fora <br /> GROUNOWATES; SURChAll <br /> ..:1 Iday Y J64_ `..98.. VU <br /> �... - ut .,c ... . .. <br /> en7 <br />