HomeMy WebLinkAbout038-1074-10-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal informalion you provide may be used for secondary purposes (Privacy Law S 15 C41l,rri]
1ANK INFORMATION
CAPAC
TANK SETBACK INFORMATION
TANK TO
PIL
WELL
BLDG
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMPISIPHON INFORMATION
5VIL ALISORIPTION SYSTEM
ELEVATION DATA
3enchmark
Alt BM
Dt Bottom
System
County St, Croix
Sanitary Permil rf�
633974
Stara Plan ID No
Parcel Tax No
038-1074-10-000
Sect,on,To,,n,Pange'%1ap No
17.31.18,306B
BS I HI
BEDITRIENCH
Vvdth
Length
No Of Trenches
Of Pits
Inside Did
Liquid Depth
DIMENSIONS
I
I
ri7l)�
I
I
SETBACK
SYSTEM TO
PIL
BLDG
WELL
�KEiS�TREAM
IManufadwrer
INFORMATION
CLEACHING
IIAMBEIROR
I
Type Of System
i Model Number
UNIT
DIST ikimu I 1UN S T Z' I tm
Header!M.nif.ld
Hole Size
Hole Spacing
Vent to Air Intake
jD:stnbuf.n
P pe(s)
ix
ix
Length_ DI1_
Leri Dia. Spec,ing_
SOIL GOVEK X Pressure Svstems OnIv xx Mound 0, (Imil.
Depth Over
Depth Over -----
Fx 'Oepthof
Seededl
Mulched
Bed/Trench Center
Bed/Trench Edges
Topsoil
1�
El es No
Y
COMMENTS: (Include code discrepancies, persons present, etc.)
Location: 965 BRAVE DR
1 ) Alt BM Description
2 ) Bldg sewer length
- amount of cover
Plan revision Required? Yes �— No
Use other side for additional information
SBD-6-10 �R 3197', --Date
Inspection #1 Inspection #2
Inseppors Signature
Cen No