HomeMy WebLinkAbout020-1485-03-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes (Privacy Law, s 15 04 (1)(m)]
John & Madeline Gagliardi
;ST 8M Bey ' Insp BM ETv BM Descr`ptio'n,�
I •0 I GO , 0 / LEI -mac- I
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
Z SQ
Dosin
Aera
Hal g
TANK SETBACKI`NFORMATION
PUMP/SIPHON INFORMATION
to
SYSTEM
TOWN OF HU
u
r ?/� pvL p?
ELEVATION CA
STATION
SS
HI
FS
ELEV
Benchmark
Ia
o�.l
vo,D
Alt BM
us
2-S.r•
,n,n.,i,.�
Bldg Sewer
SUHt Inlet
SUHt Outlet
O
Dt Inlet
Dt Bottom
/
Header/Man
�
I o(.8
• �
qa. es'
Dist Pipe
Bat System
•O
CE
.O
.O
Z • QS
Final Grade
St Cover
/
�i�owt�j �
I•
CI0/'��
I °�3D
l�l,
loc.
u %Aw pure r
R N
DIM NS
Wi th
31
LeQngth f
16 4 r,
1 UP/•L
No Of — enchas
2\
`PIT
DIMENSIONS
•No Of Pits
Inside Dia
Ligmtl Depth
SETBACK
INFORMATION
SYSTEM TO
BLDJG
WE
LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Manvf ctu
Typpe III"
/•_ nJ„__ 1
lUl'' �'n.1 t
'7 r
/+wiG�
.t„ I
Model N er
VIV I INIYV I IVI\ J 10I CIYI
eetler a 'r N Oislnbuuon x Hole S¢e x Hole $pacing Vent to Av Intake
Length ` v Dia� LenBt�� Di� Spacm>✓� >
SOIL COVER x Prncenra Sacmme fln6. — kl A. n• r_._w
Depth Over
Depth Over
xx Depth of
xx Seeded Sodded
a Mulchetl
BedrTrench Center
BetleTrench Edges
Topsoil
Yes No
_Vas 4'0
V rr9MENTS; (In Jude codde2disTpencies persons present, etc.) %Innsspeecction #1
a Fon 8422CCEDAR�BERRY CT ^� • L� AA� •'�'r"^""-�` •'�' �' � Se i I S
1.) Alt BM Description =
t
2 ) Bldg sewer length = 2.z
- amount of cover = > 24 Ir .
3)�rJc�a. i;Pes Li
Plan revision Required? L t Yes fy'
U e other side for adddwnal informaUor
Jam) 9 i A 1 ri¢e� IDT % so rr� � #E W I E56 C
Inspection #2.
N