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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 /> All revisions to [his perrn'd must be apprr.ved by the ne -s,—rig a.iil-ei ity. A new permit may h_ r•eede''
<br /> H ih_,�e is a chargo In you, build ng fans. sy t Ic c='flmated Nastewat�r flc%N r - rrtper of bc,4
<br /> rooms, etc l depth of system, of type of ;:ys'ur,
<br /> ".I )1 ,n ,)vd,i—S! , G pli, mb, t ,, , Sn : - r �'r R:. iE✓va :1- oC;r; F,'?93: tp I f
<br /> s,.,bmitted to the county prior to netailafl(.r.
<br /> sewage Syst,ms- usl p „acrh ;r, d r �:er. _..,;:.,. „ ,,, .,fIL_Id ba p-mp::d by ccrrsed
<br /> DJri ret whenPvr_r np('es i ) -.:d e%r'"v ..
<br /> _it rNis, i, hUre (I ..r,.r r C :nc-'. .
<br /> �'. to
<br /> Inn mher I, .r',i. ,. , w Iwt IIinU.
<br /> P'IrpSJE of appiicatlo.) C'.hecK ori'% c i)e I�? i. lr,!�i,k, I' oeriai' .,[ tanK rB piaCement, IeC01 neC'!On Jr
<br /> repair,
<br /> :'I/ of system- check all appropriate boxes depending on system type. Check experimental only if project
<br /> is in conjunction with University of Wisconsin,
<br /> V. Absorption system informationProvide all information requested in ##1-6',
<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 nameindicate prefab or site constructed and tank material. Complete
<br /> for all septic, lift/siphon 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 (e_g_
<br /> MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if
<br /> applicable,
<br /> Vlll. Soil test information. Certified soil tester's name, certiflcatior Number address, and phone number
<br /> IX. County/Department Use Only..
<br /> X- Comment area for use by counts or resaon giver when applicatioe is disapproved
<br /> Complete pians and specifications not smaller than a'':: - 11 inches must be submitted to the -ourty. The
<br /> plans must include the following- AI plot plandrawn to scale or with complete dimensions, location o`
<br /> holding tank(s), septic tank(s', or other treatment tanks: building sewers wellswater mams!water service.
<br /> streams and lakes. dosing or pumping chambersdistribution boxes: soil absorption systemsreplacement
<br /> system areas; and the location o` the building served B? horizontal a:—.d vertical elevation reference pants:
<br /> C) complete specifications for pumps and controlf,. dose volume; elevation differences, friction loss: pump
<br /> performance curve: pump model and pump manufacturer, M cross section of the soil absorption system i`
<br /> required by the county, E) soil test data on a 115 fora
<br /> GROUNDikAFE�. SDRC rIARGE
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