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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 applicable; <br /> Al' revisions to this permit must approved by the pe- sulrig author ty. A rew permit may b r r:deu <br /> i' there is a change '.rr yo,j b ild lg ,Macs system locate extimate' wastewater flow !number ci beC- <br /> roorns, etc-), depth of system o, ypc of system <br /> 4 Chances in l- :5r NI,.mL.- , ru,.-cs a Samta: cw,, F. i f -3'49. <br /> submitted to the county prior to ifst-iliaton. <br /> Privatu sewage .rystrr,s —J-. b" properly mai ttaii�ec iai flz, ,fcc—icl b, :ed <br /> ln,rnaer v✓hene ' 1,( c <br /> p 'c ,3 <br /> ri Ilinl-I :, .r .le far ,lly 4W, '.ins, <br /> Purpose of app's •ei;oc- Clio-- o�� 0 ion Jlete;r It :)ermit is fof tanr f. <br /> repair, <br /> Type of system. check all approp �ate boxes depending on system type- Cheek experimental only if project <br /> is in conjunction with University of Wisconsin, <br /> V. Absorption systern informationProvide all information requested in 41-6; <br /> VI. Tank information: Fill in the capacity 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 all septic, lifUslphon chamber and holding tanks for this system- Check experimental approval only if <br /> tanks received experimental product approval from DILHR; <br /> VII. Responsibility statement. Installing plumber is to fill In name. license number with appropriate prefix le-g <br /> - <br /> VIP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if <br /> applicable; <br /> VIII. Soil test information: Certified soil.tester's name, certification number. address, and phone number <br /> IX. County/Department Use Only, <br /> X- Comment area for use by county or resaon given when application Is disapproved <br /> Complete plans and specifications not smaller than B'e • 11 Inches must he submitted to the ccou-ly. The <br /> plans must include the following: A) plot plar, drawn to scale or with complete dimensions. location a' <br /> holding tank(s), septic tank(s,` or other treatment tanks. building sewers, wells water mains/water service. <br /> streams and lakes: dosing or pumping chambers distribution boxessoil absorption systemsreplacement <br /> system areas: and the location o` the building served- R) norizontal and vertical elevation reference points; <br /> C) complete specifications for pumps and Controls dose volume, elevation differencesfriction loss, pump <br /> performance curve; pump mode' and pump manufacturer; D) cross section of the sol' absorption system i'. <br /> required by the county, E) soil test data or, a 115 fora:. <br /> GROUNDWATER SURCHARGE <br /> , -',av t 1984yr s„u <br /> -- 2 <br /> Y , <br /> _ - Vis..:: . .>wa,«. <br />