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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 rerowed before the expiration date. and at the time of renewal any new
<br /> criteria in the Wisconsin Administrative Code wiil be applicable;
<br /> ? AIi revisions to this perm,t r usi t'.r, appr.nred by the peri it csuing autho'ity A new permit may hF rr,,ot.j
<br /> if there is a change m yo ouik'l:'g ,—r' syste lo.al. 1 est,rnated wastevvator flow (, umber _f beta
<br /> rooms, etc 1, depth Of system or type of sys?ern
<br /> ,^,ranges w :,wr rrsh,t cr pl;.rnt, . thine-, a .a ,a'. . - r ..r.sfe R.'r,ev i 1
<br /> submitted tc the county p- or to !..t;. r
<br /> 'f ware savage srs,cros n,,', be. , ,pct. �oa �'„ r-,ec. .. p;:� ;a -Is; she l�
<br /> ,m,,,, v;henesr-r r ,.:est _•. _ _.
<br /> i Mhlir c, _ - , .o- r wc. fanuly 'wri in
<br /> rsrpusc of apps at,o, .;her.ti u r` ji on .r12!e nL i1 uermrf is lo'. rant rei..a, erre i. -cor-ie: r,
<br /> repair;
<br /> Type of system_ check all approj r ate boxes Cependeig 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 41-6,
<br /> VI_ Tank information_ Fill in the capacity of every new and/or existing tank, list the totai 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 DILHR;
<br /> VII. Responsibility statement. Installing plumber is to fill it name, license number with appropriate prefix (eg
<br /> -
<br /> VIP, etc.), address and phone number Plumber must sign application form_ Fill in designer name if
<br /> applicable:
<br /> Vfll. Soil test information Certified sc;i testers name, ce:tificatior numberad: ress. and phone nurnbe:,
<br /> IX. County/Department Use Only.
<br /> x. Comment area to: use by county or resaon giver when application Is disapproves
<br /> Complete. plans and specifications not smalier n ,n 11 inches must he submitted to +he aunty The
<br /> puns must include the following_ A; plot plan drawr to scale or w.th zomolete_dimensions, location or
<br /> holding tankrs), septic tank(s; or 'her treatn'ent tanks: hubc,ng sewers: wells water mains/water serv'.ce
<br /> streams and lakes, dosing or pumping chamoers, distribution boxes: soil absorption systems. replacement
<br /> system areasaria the location o` thr- bu'.idiny serve, B, nor+zontal and vortical elevation reference pointn.
<br /> complete specifications for pumps and controls dose volume: elevation differences. friction loss: pump
<br /> performance curve: pump model and purnp -anufac`-ire:, D' cross section. of the sol! absorption system
<br /> required by the county. E'' soil test data on a 1-.15 forrr .
<br /> GROJN✓WATEF: SUR--i-,ARGE
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