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INSPECTION REPORT ,D d 624624998
GENERAL INFORMATION (ATTACH , II TO WPERMIT) us,wnlD xv.
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Rantly Robertson cr M TOWN OF SOMERSET In.x 032-2174-2MOO
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TANKINFORMATION ELEVATION DATA
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MANUFACTURER
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Cover Page
Shaun Bird
Bird Plumbing Inc
1432 120th St
Now Richmond Wi 54017
715-246-4516
Date 9/17120
Owner! Randy Robertson
Location SW1/4 SE1/4 S22 T31 N,R19W 201157th at. Somerset
System type In ground absorbtion system(conventional)
Manuals Used! Inyrountl absorbtion system (version 2.0)
Pressure Distribution Manual (version 2 0)
Page#
1 Cover Page
2-3 Plot Plan
4. EZ-Flow CrossSection
S-7 Ma7422
Contingency Plan
7 F'a,k
formSignatuLicense900
System PLOT PLAN
PROJECT Ran& HOLetlson ADDRESS 20115Tn B1 SOmB2e1 Wi W25
5W IIA SE 114s 22 IT 01 NIR 19 W TOWN SN"Diat COUNTY ST CROIX
SYSTEM ELEVATION 94 MIX 015bebx 01d00 9116YO BEDROOM 4
DATE
CONVENTIONAL AT -GRADE CONVENTIONAL LOT .W. HOLDING TANK
MOUND_ SEPTIC TANK SIZE 1260 IJA' TANK SIZE600 DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 5 ABSORPTION AREA 1200 # of EZ-Flaw[24
,BENCHMARK V R P NXI in 18nee ASSUME EIXVAI'[ON 160' Filter Poly mk5251/
❑BOR HOLE O RILL .H R P BB111B 9800ndITdA
See attached plot plan for design and site specs.
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Cross Section of a Two Cell EZ Flow In -Ground Dispersal Component
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Cell 4- Observation Pipe
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System Elevation
Ce1111R -
Tremment and Dispersal Area
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Final GmWI Ft Final GradI Ft
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ST. CROI% COUNTYCERTyONING OFFICE
FOR UTILIZATION
FICA9.ION STAT$MENT
ZATION OF AN 8%ISTING SBPTIC TANS(
CtV ng rh certifythaC I have i tel
the septic tank
scrvin /
G pre
sently
��'• tion 'z rest new located at;
T`N the tanks Upon inspection _W, Town of
and battles I certify that I hto bI e In good condition, anave fanny
d if
lunotiohing properly. appears to he
Gst time serviesj n
>>d Ilow pack Decor P5 [tramNo (I£ a sorption sys D ystemo
_L\no, skip next line) Approximate volute or length of time:
',paelty/200 / gallons minutes
Construct'-': prefab Concratex
Manufa re (IP known): 4 Steel � Other
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A.)e a T nk If known)ZX eP/i.i1
nature) / V
(,tie) (Naee) pleas Print
J1JiFj
Ite
tort to h
Se completed by licensed pluehar (s.14i a6, Wisconsin
Code) tatutes) or Li caused Disposer (NR 113 Nlsconein .06st rat we
Flumber (applying fer sanitary Noteiq Certification: [n accepting the above statement regard''
condition, I Certify that tAeo tank to g existing septic Wank
inspect to openi �overe oa f IIl R a �e a tCadeovledeget for
C�`tP cutlet gaff (e P
me ✓% >���
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