HomeMy WebLinkAbout032-2174-10-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Buflding Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes (Pnvacy Law, s 15 04 (1)(m))
�Quiiy St. Croix
Sanitary Permit No
633848
State Plan ID No
PermitHolde,`sName
Oevering Homes
City Village Towr5hip
I TOWN OF SOMERSET
Parcel Tax No
032-2174-10-000
CST BM Ell
Insp BM Elev
1
By Description
1
Sectionrfown/RangelMap No
27.31.19.1465
ANK iNrumile i
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
PUMPISIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
DHT
System Head
TDH Ft
or .in
Forcemain
I Length
D,,..
Dist to Well
SOIL ABSORPTION SYSTEM
t:l I ILIN UIA I A
STATION
BS
HI
FS
ELEV.
Benchmark
Alt. BM
Bldg Sewer
St/Ht Inlet
St/Ht Outlet
Dt Inlet
Pit Bottom
Header/Man,
Dist Pipe
Bot System
Final Grade
St Cover
BED[TRIENCH
Width
Length
No Of Trenches
PIT DIMENSIONS
Of=ia
Depth
DIMENSIONS
I
I
I
ji
IlLiquid
SETBACK
SYSTEM TO
1PIL
IBLDG
IWELL
LAKE/STREAJ
IManufaciureir
INFORMATION
CLEACHING
HAMBER OR
UNIT
Type Of System:
i Made Nuni
DISTRIBUTION SYSTEM
Header/Manifold
x Hole Size
Hole Spacing
Van
iLehgth_Di,_
IlDistnibuthan
Pipets)
Length Dia_ Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Depth Over
Depth of
SeedediSodded
Mulched
BedfTrench Center
Bedr-rencin Edges
To
I" psoil
Yes
COMMENTS: (Include code discrepancies, persons present, etc.)
Location: 1990 57TH ST
1.) Alt BM Description
2.) Bldg sewer length
- amount of Cover
Inspection #1
Plan revision Requireci E] Yes E No
Use other side for additional information
SBD-6710 (R 3,97) Date linseptoor's Signature
Inspection #2
Cart No