HomeMy WebLinkAbout026-1306-00-040Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No 633868
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No
Personal information you provide may be used for sewinday pmjp�es [Pnvacy Law, a 15 04 (1)(ini
IpEorit Holder'sgame City Village Township Parcel Tax No
ugene Amy Coulter I TOWN OF R1 026-1306-00-040
CST BM Elev Insp BM Bay BM Description Section[Town�Rangellvlap No
1 1 18.30.18.1647
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
fielding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMPISIPHON INFORMATION
Manufacturer
Demand
Gall
Model Number
—
DH
7
L, ft
:F f
nc ion Loss
L05S
S te
Syst;m Head
TDH Ft
mTF _.in
TLn� 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
Bat. System
Final Grade
St Cover
BEDuTRENCH
DIMENSIONS
dth
Length
I
No 0 Trenches
PIT DIMENSIONS
No Of P,ti,
Inside Dia
Liquid Depth
I
SETBACK
INFORMATION
SYSTEM TO
jP;L
JBLDG
IWELL
LAKE/STREAM
LEACHING
CHAMBE R OR
UNIT
Manufacturer
Type Of System
Model Number:
DISTRIBUTION SYSTEM
Header/l
IlDistribution
Hole Size
Hole Spacing
Vent to Air Intake
iLeagth_
Ix
ix
One _lPipe(s)
Length Do Spacing
_
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Depth Over
Depth of
SeedediScidded
xx Mulched
Bedrrehch Center
BedFrrench Edges
To psoil
1:1 Yes E] No
E]Yes
COMMENTS: (include code discrepencies, persons present, etc) Inspection #1
Location: 1517 96TH ST
1.) Alt BM Description
2.) Bldg sewer length
- amount of cover
Plan revision Required? ::] Yes — No
Use other side for additional information,
Date
SBD-671 0 (R T97)
Iri Signature
Inspection 42.
Can No.