HomeMy WebLinkAbout032-2044-30-090 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Persona[ information you provide may be used for secondary purposes [Privacy Law 5 15 04 (1)�nl
Permit Holders Name Village Township
Chad Miller TOWN OF SOMERSET
ICST BM Elev Imsip BM El;v IBM Description
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septtc
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
PIL
WELL
BLDG
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMPISIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
CH
Lift
Friction Loss
System Head
TDIT Ft
F 'rc'msu;
Length
Dia
Dist to Weill
Z)UIL At$bUKF I IUN 5Y5TEM
ELEVATION DATA
STATION
BS
HI
FS
ELEV.
Benchmark
Alt BM
Bldg Sewer
St/Ht Inlet
St1Ht Outlet
Dt Inlet
Dt Bottom
Header/Man
Dist Pipe
sot System
Final Grade
St Cover
BEDITRIENCH
Width
Length
No Of Trenches
PIT DIMENSIONS
Of Pits
Inside Dia
Liquid Depth
DIMENSIONS
I
I
I
IN.
I
I
SETBACK
SYSTEM TO
P/L
�G �WEILL
LAKEISTREAM
I LEACHING
livenufacturer
INFORMATION
CHAMBER OR
I
Type Of System
i Model Number
I
I
UNIT
Ulb I KIII:111.1 I IUN bYZ3 I EM
HeaderlManifold
IDistribution
Hole Size
Hole Spacing
Pipe(s)
ix
Lenggh_ Dja_
iLength_ Dia_ Spacing_
�Vll— l-UVEM x pressure Sv%tp.m.q i . M[rauri n, Af.rir.dja Q-1— 71.1.
Depth Over
Depth Over
Depth of
Seeded/Sodded
Mulched
Bed/Trench Center
I
BedrTrench Edges
Topsoi
I-
IKX
Yes _] No
— y
—
COMMENTS: (Include code discrepancies, persons present, etc) Inspection #1 Inspection #2
Location: 1665 87TH ST
1.) Alt BM Description
2 ) Bldg sewer length
- amount of cover
Plan revision Required? E] Yes --1 No
Use other side for additional information L
SBD-6710 (R 3/97) Date linseloctor's Signature Can No