HomeMy WebLinkAbout032-2018-70-055 (2)Wisconsin Department of Commerce
PRIVATE SEWAGE SYSTEM
St. Croix
Safety and Building Division
INSPECTION REPORT
Sanitary Permit No
GENERAL INFORMATION
(ATTACH TO PERMIT)
633904
State Plan ID No
Personal information you provide may be used for secondary purposes [Privacy Law, s 15 04 (1)(m)]
Permit Holders Name
City Village Township
Parcel Tax No
Jean Milton
I=E�',—
I TOWN OF SOMERSET 1
032-2018-70-055
Insp. BM Elev
IBM Description I
Seqtion,rTowWRanod1MaD No
TANK INFORMATION
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
Number
Loss
SOIL ABSORPTION SYSTEM
ELEVATION DATA
STATION
BS
H I
FS
ELEV
Benchmark
Alt, LIM
Bldg Sewer
SUHT Inlet
SUM Outlet
Dt Inlet
Dt Bottom
Header/Man
Dist Pipe
Bot. System
Final Grade
St Cover
BEDrrRENCH
Width
Length
No Of Trenches
PITDIMENSIONS
No OfPits
Inside Din
Liquid Depth
DIMENSIONS
I
I �
I
I
I
I
SETBACK
SYSTEM TO
I PIL
JBLDG
IWELL
r
'
INFORMATION
CLEACHIN
HAMBER OR
JN11
Ilvanufacturer
Type Of System
I M.d.1 Number:
DISTRIBUTION SYSTEM
Header(Mamfold
IDistrIbution
x Hole Size
Hole Spacing
Plpe(s)
Ix
I
Length_ Dia _
iLength_ Dna_ Spacing
SOIL COVER x Pressure Svistems Oniv xx Mound Or At -Grade S%rsterns OnIv
Depth Over
Depth Over
Depth of
Seeded/Sodded
Mulched
Bed/Trench Center
I
BedrTrench Edges
I
1xx
Topsoil
1xx
1-1 Yes F-] No
1xx
1-1 y
COMMENTS: (include code discrepancies, persons present, etc.) Inspection 41 Inspection #2
Location: 493 180TH AVE
1 ) Alt BM Description
2.) Bldg sewer length
- amount of cover -
Plan revision Required? Yes L] No
Use other side for additional information.
SBD-6710 (R 3197) Date linsenctor's Signature
Cert No