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INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
<br /> APPLICATION
<br /> TO THE APPLICANT:
<br /> i. This sanitary permit is valid for two (2) years.
<br /> 2_ Your sanitary permit may he renewed before the expiration date, and at the time of renewal any new
<br /> criteria in the Wisconsin Administrative Code will be app!icabie.
<br /> 3 AI' revisions to this perm-I n.;st be approved by the permit ie suing authority A new pern t may c r--:d'._`
<br /> ,f tha-e is a change in yo h ;d ns p ars, systrr- -o, ah. e5[mate:f wastewater flow r r rrmbe: cf bc'
<br /> rooms, etc.), depth of systemor type of sVsten
<br /> �,h3 ; t✓a aW rc - J. riL.311.x- i {u �tit. d �rt -. oli�f� FZry1tS� ti i pili- � D .e�`; I : .
<br /> submitted to the county prior le i:,Gt Id'
<br /> ,a+c :,ewa c s...;ns u, .� e;I rnr, r
<br /> g y :,p y �.. � _ _ ...... .�; Thr__ .. ..c f,,.rcpt., „y _; _..,.
<br /> fn;m er m he,i ,, V—n _ ..
<br /> 4i
<br /> J aL: n crit r ,�� ' ._ r 1 Vv,, f9rnilV IWeli.inc
<br /> P.,rpose of apphcatlo n. Check. on _ i 4: _ _^e .rZ oenn.f ;s for tanrc re;-lacemem, recur e:. o1.
<br /> repair,
<br /> Type of systemcheck, all approp;late boxes :;epend!,,g un system type- CI)eCK experimental only if project
<br /> is in conjunction with University of Wisconsin:
<br /> V. Absorption system information: P,ovide 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 a//septic. lift/siphon chamber and holding tanks for this system. Check experimental approval only if
<br /> tanks received experimental product approval from DIL IR,
<br /> VII_ Responsibility statement. installi;tg plumber is to fill ire name. license number with appropriate prefix (e.g.
<br /> MP, etc-), address and phone nurnbe. Plumber must sign application form_ Fill in designer name if
<br /> applicable:
<br /> VIII. Soil test information- Certrfled soi, tester's namece-:ificatior aurnbe, address, and phone number.
<br /> IX, County/Department Use Only
<br /> X. Comment area for use by county or r esaan g.val wh-r: apphcat;-r is disapproved
<br /> "omplete plans and specifications not srnalle; tY an 9" 11 ,ncbes must be submitted to the county. The
<br /> plans must include the following_ A.) p!ot plandrawr to scale or with complete dimensions, location or
<br /> holding tank(s). septic tank(s: or other treatmen', tanks. be;id,ag sewe,s.. wells. water mamsiwate, service
<br /> streams and takes, dosing or purnpmg chamoersdso tbution boxessoil absorption systems replacement
<br /> system areas, and the locatior o` the buddmn se,ved B, )or zontaand eo,tica' elevation reference points:
<br /> �) complete specifications for pumps and controls, dose volume; elevation differencesfriction loss, pwrip
<br /> performance curvepump model and pump man factorer:. D` cross soctiorl of the sot', system i`
<br /> required by the county; E) soil test data on a '15 fora.
<br /> GROUNUWATEF•. SURCnARGE
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