HomeMy WebLinkAbout020-1485-05-000Wisconsin Department of Commerce
Safety and Building Division
GENERAL INFORMATION
Personal information you provide may be used for
on Bast
Insp
TANK INFORMATION
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
purposes [Pnvacy Law, s 15 04 (1)(m)]
City Village Township
a
TYPE
MANUFACTUR R /7.
r
CAPACITY
Septic
Fj ler
L f7
Aeration
Holding
TANK SETBACK INFORMATION G� ►r C lwI k S
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PUMP/SIPHON INFORMATION
Manufacturer
71
Demand
4,n
Fri tion Loss
System atl
TDHth
is
Dist to II
TION DATA
STATION
BS
HI
FS
ELEV
Benchmark
Z _7
I
Al?ll//frColAar
1,3
lol.
Bldg Sewer
3. Z.
g1.5
SUHt Inlet
i 2
St1Ht Outlet
I r 7
Y 8
Dt Inlet
Dt Bottom
Header/Man,
5. �
9T. a
Disj
Pipe
lzr /
—1z
5,
9?.
of System
�t 7
Final Grade
Z_.7
(oa
St Cover !, 1
SOIL ABSORPTION SYSTEM
LZ
ZZ C 11a x,y
BEDITRENCH
DIMENSIONS
Width s Length
qv
r No Of Trenches
Z_
PIT DIMENSIONS No Of Pits
Inside Dia.
Liquitl Depth
SETBACK
SYSTEM TO
P/LW
BLDG
WELL
LAKE/STREAM
LEACHING
Manufacturer
f /
INFORMATION
CHAMBER OR
UNIT
14'
�/' 1 f ( ✓y%b/'
Tyye Of System� ` �I
/
? rjs
...7 Q
A 1^
I1/'1
�_
Model Number
/OV i G y-
UI57 HI HUN SYSTEM
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grades Rvstamq Only
Depth Over
Bed/Trench Center i g
Depth Over
Bed/Trench Edges 11 z t t
xx Depth of
Topsoil
m Seeded7Sodded
- Mulched
No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1 Inspection #2
Location: 848 CEDARBE{RR1b 1W
Y CT —No IN.CI I O , �--1
1.) Alt BM Description = ' f I i -r (" l !
2.) Bldg sewer length = 2- ' — &� Yh.Ni S 2 1D-!ld InS d i N5� �G{�n„
- amount of cover = 71�NPis
Plan revision Required [Yes yn No L
Use other side for additional mformati ( (/ !�( �f��'f"/�/ 5••,••,✓✓`�
SBD-6710 (R 3197) Dale Insepctofs Signatur Cart No