HomeMy WebLinkAbout032-2052-60-010Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may he used for secondary purposes (Privacy Law, s 15 04 (1)(m)]
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG,
Vent to Air Intake
ROAD
Septic
Dosing
7
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
7DH
Friction Loss
System Head
TDH Ft
For ,,in
-,,� th
Dra
Dist to Well
SOIL ABSORPTION SYSTEM
County St. Croix
Sanitary Permit No
633371
State Plan ID No
Parcel Tax No
032-2052-60-010
Sectionaown/Range/Map No
15.30.19.697A
STATION
BS
HI
FS
ELEV
Benchmark
Alt, BM
Bldg. Sewer
SUHt Inlet
SUHt Outlet
Dt Inlet
Dt Bottom
Header/Man.
Dist. Pipe
But. System
Final Grade
St Cover
BEDrrRENCH
DIMENSIONS
Width
Length
I
No OfTerches
I
I
PIT DIMENSIONS
I
INo Of Pits
Inside Dia
I
Liquid Depth
I
SETBACK
INFORMATION
SYSTEM TO
P/L
BLDG
]WELL
LEACHING
CHAMBER OR
UNII
IManufacturer
Type Of System
I
I Model Numt>er
DISTRIBUTION SYSTEM
HeaderiMan[fold
IDistinti.tion
Hole Size
Hole Spacing
Vent to Air Intake
iLength_Dia_
ix
Is
I
jPpe(s)
Length Da Spacing
SOIL COVER x Pressure Sorsterns Dull xx Mound Or At -Grade Svstems Dinh,
Depth Over
Depth Over
Depth of
Sereded/Sodded
Muiche<i
IBedffrench Center
Bed[Trench Edges
I
ITopsoil
Iyx Yes � I No
F-1 Yes[ —1 No
COMMENTS: (Include code discrepencies, persons present, etc I
Location: 607 160TH AVE
I ) Alt BIV Description =
2 ) Bldg sewer length -
- amount of cover =
Plan revision Required? 0 Yes I � No
Use other side for additional information.
Date
SBD-6710 (R.3197)
Inspection #1: Inspection #2:
InseIrctoes Signature Ced. No