HomeMy WebLinkAbout034-1067-50-025 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix
Safety and Building Division INSPECTION REPORT Sanitary Permit No SAN-2021-260
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No
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Permit Holders Name I City Village Township Parcel To. No
Jon & Melissa Kuhn (Weyer) TOWN OF SPRINGFIELD 034-1067-50-025
CST BM Ell Insp. BM Ell BIA Description SectionFrown/RangelMap No
I I 30.29.15.461A-10
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANKTO
P/L
WELL
BLDG
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
DH'Lift
7
—�bord Loss
Eric Loss
Syst" on Head
Syste
TDH Ft
or ...
Liart� th
Diia.
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
Bot System
Final Grade
St Cover
BEDrrRENCH
dth
Length
No Of Trenches
PIT DIMENSIONS
No Of Pits
Inside Dia
Liquid Depth
DIMENSIONS
i
I I
I
I
SETBACK
SYSTEM TO
JP/L
JBLDG
IWELL
LAKEISTREAM
LEACHING
—
Manufacturer
INFORMATION
CHAMBEROR
UNIT
Type Of System
Model Number
DISTRIBUTION SYSTEM
Headerfiviamfold
IDistribution
x Hole Size
Hole Spacing
Vent to
Plpe(s I
Is
I
Dia _
I Length Do Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Depth Over
Depth of
Seeded/97ded
Mulched
Bedrrredch Center
BedTionch Edges
To
1� psoil
Yes L No
1XX Yes
COMMENTS: (Include code discrepancies, persons present, etc.)
Location: 2750 HWY 12
1.) Alt BM Description =
2.) Bldg sewer length —
- amount of cover =
Inspection #1.
Plan revision Required� [-_] Yes E No
Use other side for additional information
SBD-671 0 R 3/97) Date insepcors Signature
Inspection #2
Cent. No.