HomeMy WebLinkAbout032-2167-31-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County— St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No 633873
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal infornration you provide may be used for secondary purposes l Law, a 15 04 (1)(m)]
Permit Holders N me City Village Township Parcel Tax No:
Pine Cliff Properties LLC I TOWN OF 032-2167-31-000
CST BM Elev linsip BM Ell 13M Description Sectionf-rown/RangelMap No
1 1 26.31.19.1411
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
Aeration
Holding
PUMPISIPHON INFORMATION
M anufacturer
Demand
GPM
Model Number
I
OR
Litt
:FrIcIron Loss
n Loss
System Head
Sys"'
TDH Ft
F prormam
Lear th
Dia.
Dist to Well
SOIL ABSORPTION SYSTEM
STATION
BS
HI
FS
ELEV
Benchmark
Alt. BM
Bldg. Sewer
St/l Inlet
St/Ht Outlet
Dt Inlet
Dt Bottom
Header/Man.
Dist Pipe
Bot. System
Final Grade
St Cover
BEDITRENCH
idth
Length
No 0 Trenches
PIT DIMENSIONS
No Of Pits
Inside Dia
Liquid Depth
DIMENSIONS
I
I
I
SETBACK
SYSTEM TO
JPIL
JBLDG
IWELL
LAKEISTREAM
LEACHING
Manufacturer
INFORMATION
T
CHAMBER OR
UNIT
yp e Of System
Made Number
DISTRIBUTION SYSTEM
Header/Manifold
x Hole Size
Hole Spacing
Von
IlLength
Fistribubon
Plpe(s)
,,,a-
Length Dra Spacini
SOIL COVER x Pressure Svstems On Iv xx Mound Or At -Grade Svsterns OnIv
Depth Over
Depth Over
Depth of
Seeded/Sodded
71 ched
Becl/Trench Center
BecTrrench Edges
Topsoil
Izz � j Yes L] No
I Ej Y
COMMENTS: (include code discrepancies, persons present, etc.) Inspection #1
Location: 636 196TH AVE
1.) Alt BM Description
2 1 Bldg sewer length
- amount of cover
-1 No
Plan revision Required? F-1 Yes
Use other side for additional information.
SBD-6710 (R�3/97) Cate Insepciar's Signature
Inspection #2:
L
Cert. No.