HomeMy WebLinkAbout032-2068-45-100 (4)Wisconsin 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, a 15.04 (1)(m]
Permit Holders Name City Village Township
River View Rentals LLC TOWN OF SOMERSET
CST BM i I Insp BM Elev T7-�tii
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
PIL
WELL
BLDG
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMPISIPHON INFORMATION
Manufacturer
emand
GPM
Model Number
DH
Lift
Friction Loss
System Head
TDH Ft
Fon"Ital
Dia
Dist to Well
SOIL ABSORPTION SYSTEM
STATION
BS
HI
FS
ELEV.
Benchmark
Alt BM
Bldg. Sewer
St/Ht Inlet
St/Ht Outlet
Dt Inlet
Dt Bottom
Header/Man
Dist Pipe
Bot System
Final Grade
St Cover
BEDITRENCH
Width
Length
No Of Trenches
PITDIMENSIONS
No Ori
Inside Dia
Liquid Depth
DIMENSIONS
I
SETBACK
SYSTEM TO
IP/L
BLDG
IWELL
LAKE/STREAM
LEACHING
Manufacturer
INFORMATION
CHAMBEROR
UNIT
T—ype Of Systeni
Model Number
DISTRIBUTION SYSTEM
Head.ird,lanufold
Distribution
x Hole Size
Hole Spacing
Vent to Air Intake
iLength_
Pipe(s)
Dia
Length_ Dia_ Spacing
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
BedFrrench Edges
ITopsoul
1�� Ll Yes D No
IKX El Yes [— No
COMMENTS: (include code discrepancies, persons present, etc.)
Location: 1631 28TH ST
1�) Alt BM Description
2.) Bldg sewer length
- amount of cover
Inspection #1 Inspection #2
Plan revision Required? I Yes ::] No
Use other side for additional information
SBD-671 0 (R.3197) Date Insepmor's Signature Cert. No.