HomeMy WebLinkAbout032-1064-95-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be u"d for secondary purposes (Privacy Law, s 15.04 If )(m)]
-FILY St. Croix
Sanitary Permit No
633953
State Plan ID No
Permit Holders Name
Jordan James
—BMEl.v
Village Township
TOWN OF SOMERSET 1
Parcel Tax No
032-1064-95-000
ICST BM Elev
FI..p
IBM Description I
SectionfTowmRancei No
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
VenttoA!rintake
ROAD
Septic
Dosing
I
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
DH
Lift
Friction Loss
System Head
TDH Ft
F,r,e,y,,nL,ngth
Dia
Dist to Weh
SOIL ABSORPTION SYSTEM
STATION
BS
HI
FS
ELEV.
Benchmark
AIL BM
Bldg. Sewer
SUHt Inlet
SVHt Outlet
Dt Inlet
Dt Bottom
Header/Man.
Dist. Pipe
Bat System
Final Grade
St Cover
BED/TRENCH
DIMENSIONS
Width
Length
No Of Trenches
PIT DIMENSIONS
No Of Pits
Inside Dia
Liquid Depth
I
SETBACK
INFORMATION
SYSTEM TO
PIL --TBLDG
I
IWELL
LAKEISTREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer:
-
Type Of System
I
I
I
Model Number
DISTRIBUTION SYSTEM
Header/Marnfold
IDisinbution
Hole Size
Hole Spacing
Vent to Air Intake
I
ix
ix
Length_ Da _
jPlpe(s)_
Length Dia Spacing
SOIL COVER x Pressure Svstems Oniv xx Mound Or At -Grade Svstems OnIv
Depth Over
Depth Over
Depth of
Seededi'Sodded
Mulched
BedlTrench Center
Bed/Trench Edges
Topsail
I- — - Yes E- No
1xx F Yes
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1
Location: No Address Available
1.) Alt BM Description
Z) Bldg sewer length
- amount of cover
Inspection #2:
Plan revision Required? [_] Yes —] No
Use other side for additional information.
SBD-6710 hR N97) Date Insepictor's Signature
D
Cert No