Form CEP-11 "Application for Septic Tank/Grease Trap Series Permit" - Alabama

What Is Form CEP-11?

This is a legal form that was released by the Alabama Department of Public Health - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2006;
  • The latest edition provided by the Alabama Department of Public Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CEP-11 by clicking the link below or browse more documents and templates provided by the Alabama Department of Public Health.

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Download Form CEP-11 "Application for Septic Tank/Grease Trap Series Permit" - Alabama

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CEP-11
APPLICATION FOR SEPTIC TANK/GREASE TRAP SERIES PERMIT
For Department Use Only
ALABAMA DEPARTMENT
Initial Application
______County Health Department ________Date Fee Paid
OF PUBLIC HEALTH
Renewal
______Co. Health Dept. I.D. No.
________Fee Amount
Approved
______Date Received
________Fee Code
Disapproved
______Date Issued/Renewed
________Receipt No.
Revoked
To Be Completed And Signed By The Applicant
One for Each Tank
1.
Name of Business__________________________________________ Phone No ______________________________
Street Address ___________________________________________________________________________________
City/Town __________________________________________________________ State _______ Zip_____________
2.
Name of Owner/Proprietor ___________________________________________ Phone No _____________________
Mailing Address _________________________________________________________________________________
City/Town __________________________________________________________ State _______ Zip_____________
AOWB License Number _____________________________ Expiration Date ________________________________
3.
Type of Unit
 Septic Tank
 Grease Trap
For Renewal Applications, Show Current Permit Number: ________________________________________________
Note:
If this is a renewal application, and none of the following information has changed, leave items 4 through 20 blank
and sign application on reverse.
---------------------------------------------------------------------------------------------------------------------------------------------------------
4.
Number of Forms ____________________ (Attach drawing(s) for each form)
5.
Tank Size: ____________ Gallons
Number of Compartments __________________
6.
Shape:
 Straight Wall
 Tapered
 Other: __________________________
7.
Inside Dimensions:
Length: Bottom ___________
Length Top
__________
Width: Bottom ___________
Width Top
__________
8.
Liquid Depth ____________
9.
Liquid Capacity Calculations (show calculations)
10.
Is Inlet/Outlet Ratio 2/3: 1/3?
 Yes
 No
ADPH-CEP-11/Rev 6-06
1
CEP-11
APPLICATION FOR SEPTIC TANK/GREASE TRAP SERIES PERMIT
For Department Use Only
ALABAMA DEPARTMENT
Initial Application
______County Health Department ________Date Fee Paid
OF PUBLIC HEALTH
Renewal
______Co. Health Dept. I.D. No.
________Fee Amount
Approved
______Date Received
________Fee Code
Disapproved
______Date Issued/Renewed
________Receipt No.
Revoked
To Be Completed And Signed By The Applicant
One for Each Tank
1.
Name of Business__________________________________________ Phone No ______________________________
Street Address ___________________________________________________________________________________
City/Town __________________________________________________________ State _______ Zip_____________
2.
Name of Owner/Proprietor ___________________________________________ Phone No _____________________
Mailing Address _________________________________________________________________________________
City/Town __________________________________________________________ State _______ Zip_____________
AOWB License Number _____________________________ Expiration Date ________________________________
3.
Type of Unit
 Septic Tank
 Grease Trap
For Renewal Applications, Show Current Permit Number: ________________________________________________
Note:
If this is a renewal application, and none of the following information has changed, leave items 4 through 20 blank
and sign application on reverse.
---------------------------------------------------------------------------------------------------------------------------------------------------------
4.
Number of Forms ____________________ (Attach drawing(s) for each form)
5.
Tank Size: ____________ Gallons
Number of Compartments __________________
6.
Shape:
 Straight Wall
 Tapered
 Other: __________________________
7.
Inside Dimensions:
Length: Bottom ___________
Length Top
__________
Width: Bottom ___________
Width Top
__________
8.
Liquid Depth ____________
9.
Liquid Capacity Calculations (show calculations)
10.
Is Inlet/Outlet Ratio 2/3: 1/3?
 Yes
 No
ADPH-CEP-11/Rev 6-06
1
CEP-11
11.
Inlet to Outlet Fall __________ inches.
12.
Air Space _____________ inches
13.
Baffle
 Type 1
 Type 2
If Type 2, is Engineered Certification Attached?  Yes
 No
14.
Method(s) of Securing and Fastening Baffle: ___________________________________________________________
______________________________________________________________________________________________________
15.
Dimensions of Lid/Sections:
Length __________
Width _________
Number of Sections _____________
16.
Access Inspection Holes:
Number ___________
Dimension ______________
17.
Risers cast directly into lid?
 Yes
 No
Riser Manufacturer ___________________________
18.
Thickness:
Wall ______inches
Bottom _______inches
Lid ________ inches
19.
Describe All Materials and Type of Reinforcement
Wall: __________________________________________________________________________________________
Bottom: ________________________________________________________________________________________
Lid: ___________________________________________________________________________________________
Is Engineer Certification Attached, if Needed?  Yes
 No
20.
Description of method(s) used to make system watertight:
Tank fixtures: ___________________________________________________________________________________
Between Lid/Tank/Sections (when applicable) _________________________________________________________
Risers: _________________________________________________________________________________________
21.
Tank Test Date: ___________________
Tank test certified by ______________________________
Application is made pursuant to Alabama Administrative Code, Chapter 420-3-1.
Business Owner ________________________________________________________ Date ___________________________
Signature
Health Department Review:
Local _________________________________________Date _________________________
Board _________________________________________Date: ________________________
Note: All attachments must be identified by business name, address, and telephone number.
ADPH-CEP-11/Rev 6-06
2
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