HomeMy WebLinkAbout038-1223-03-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix
Safety and Building Division INSPECTION REPORT Sanitary Permit No: 633910
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No.
Personal information you provide may be used for secondary purposes [Privacy Law, s 15 04 (1)(m]
Pernnit Holders Name City Village Township Parcel Tm. No
Christopher T. and Rebecca D. Short TOWN OF STAR PRAIRIE 038-1223-03-000
BM Description Sectionrl-ownRangeavale No
CST BM Ell --7p� 1 04.31.18.1240
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
I
Aeration
Holding
PUMPISIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
I
TDH
Lift
Friction Loss
System Head
TDH Ft
Forcemann
I Length
Dia
Dist. to Well
SOIL ABSORPTION SYSTEM
STATION
BS
HI
FS
ELEV.
Benchmark
Alt BM
Bldg Sewer
SUM Inlet
SUM Outlet
Dt Inlet
Dt Bottom
Header/Man.
Dist Pipe
Bot System
Final Grade
St Cover
BEDIFTIRENCH
Width
Length
No Trenches
PITDIME SIONS
No OfPas
Inside Ora
Liquid Depth
DIMENSIONS
I
I
I
SETBACK
SYSTEM TO
IP/L
JBLDG
IWELL
LAKE/STREAM
LEACHING
—
Manufacturer
INFORMATION
CHAMBER OR
UNIT
Type Of Systere
Model Number
DISTRIBUTION SYSTEM
Header/Manifold
Hole Size
Hole Spacing
Vent to Air Intake
iLength_D,a_
IlDistinbunton
Roofs)
Ix
Length Die Spachg_
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Depth Over
Depth of
Seeded/Sodded
Mulched
Bed/Trench Center
Bed/Trench Edges
11-orlsoil
L] Yes No
Yes
COMMENTS: (Include wide disuepencies, persons present, etc )
Location: 2390 108TH ST
1.) Alt BM Description -
2�) Bldg sewer length -
- amount of cover �
Plan revision Required? L] Yes [] No
Use other side for additional information —1
Date
SBD-6710 R3197)
Inspection 41 Inspection #2
Insepctors Signature
Cent No