HomeMy WebLinkAbout030-2113-80-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes Pnvacy Law, s 15 04 (1)(mul
Perm t Holders Name City Village Township
Coilin & Sarah Marnach I TOWN OF SAINT JOSEEIH
ICST BM Eiev Imsip. BM Elev IBM Description
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANKTO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
I
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
D�H
Lnt
Friction Loss
System Head
TDH Ft
For main
-,,� th
Dia.
Dist. to Well
SOIL ABSORPTION SYSTEM
STATION
BS
HI
FS
ELEV.
Benchmark
Alt. BM
Bldg. Sewer
St/Ht Inlet
St/Ht Outlet
Dt Inlet
Dt Bottom
Header/Man.
Dist. Pipe
Bet. System
Final Grade
St Cover
REDITRENCH
Width
Length
No�� Trenches
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
DIMENSIONS
I I
I
SETBACK
SYSTEM TO
JPJL
JBILDG
IWELL
LAKIE/STREAM
LEACHING
—
I Manufacturer
INFORMATION
CHAMBEROR
UNI I
I
Type Of System
I Model Number
DISTRIBUTION SYSTEM
Header/Manifold
IDistribution
x Hole Size
Hole Spacing
Vent to Air Intake
iLength_
Pipe(s)
ix
Dia_
ii-ength Dia Spacing
SOIL COVER x Pressure Svstems Orl xx Mound Or At -Grade Svstems OnIv
Depth Over
Depth Over
Depth of
Seeded/Sodded
- Mulched
BedFrrench Center
Bed/Trench Edges
Topsoil
1- 11 Yes E] No
1 ::1 Yes
COMMENTS: (include code discrepancies, persons present, etc) Inspection #1: Inspection #2
Location: 324 WHITE EAGLE TRL
1.) Alt BM Description
2.) Bldg sewer length
- amount of cover
Plan revision Required? E] Yes [] No
Use other side for additional information
SBD-6710 TZ 3197) Date lnsepcto�iignalure Cert No