HomeMy WebLinkAbout026-1306-00-003 (4)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Di sion
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s 15 04 (1)(m))
Permit Holders Name City Village Township
SET IN STONE COLINTERTOPS LLI I TOWN OF RICHMOND
ICST BM Elev Ilrap BM El.v IBM Descricio. I I
TANK INFORMATION
CAPACITY
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG
',ent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMPISIPHON INFORMATION
IForcernam 11-ength jDha I Dist to Wall
.qnll AR(;nRPTI0?J qY(ZT;:M
ELEVATION DATA
Inlet
Bottom
Dist Pipe
Final Grade
BS
BEDITRENCH
DIMENSIONS
Width
Length
I
No Of Trenches
FIT DIMENSIONS
I
No Of Pits
I
Inside Die
I
Liquid Depth
I
SETBACK
INFORMATION
SYSTEM TO
IP/L
BLDG
IWELL LAKE/STIREAM
LEACHING
CHAMBER OR
until
M-m-fact....
I
Type Of System
I Model Number
UIS I KIMIJ I IL)N bTb I trill
Ha.da,2Manifold
I Distribution
Hole Size
77 71e Spacing
Vent to Ai
iLehgth_
1�
D a_
jP,peIs
Length_ Dia Spacing_
SCAL CCjvt:K x Pressure Svstems Oniv xx Minund (Ir At-pI Rv�tanm, nniv
Depth Over
De th Over
Depth of
Seeded!Sodded
Mulched
Bad�rench Center
Bed/Trench Edges
Topsoil
I"
�:] Yes L' No
F1 Yes
COMMENTS: (include code discrepencies, persons present, etc I Inspection #1
Location: 988 154TH AVE
I Ali BM Description
2 Bldg sewer length
- amount of cover
Plan revision Required� — Yes — No
Use other side for additional intormation
SBD-6710 (R 3/97) Date Insenctor s Signature
Inspection #2
Cert No