HomeMy WebLinkAbout030-2161-06-300Wsponsin 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)(ni
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
PiL
WELL
BLDG
Vent to Air Intake
Septic
Dosing
Aeration
Holding
PUMPISIPHON INFORMATION
Manufacturer
Model Number
TDH Lift Friction Los S,
ss S'
Forcemeat I Length D, 7a
SOIL ABSORPTION SYSTEM
STATION
33
HI
FS
EIEV
Benchmark
Alt BM
Bldg Sewer
St/Ht Inlet
St/Ht Outlet
7 Inlet
Of Bottom
HeaderlMan
Dist Pipe
Bot System
Final Grade
St Cover
BEDITRENCH
DIMENSIONS
[',Vldlh
Length -No
I
Of -Trenches
I
PIT DIMENSIONS
No Of Pits
Inside D,a
Liquid Depth
SETBACK
INFORMATION
c
SYSTEM TO
IRL
BILDG
I"ELL
LAKESTREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer
ype Of System
�T
I
I
I
Model Number
DIS I K116IJ I ILIN Z5YZj I tM
HeaderMarrold
Hole Size
Hole Spacing
Vent to Air Intake
iLength_
ID:stribution
P pe(st
Ix
1�
I
Did_
Length_ Dia Spacing
SCAL GOvEle: x Pressure Svstams Oniv .. lilleaund ni, At.r,.H. R��t.nri Pal.
Depth Over
Depth Over
Depth of
S.ed.d/Soddad
Mulched
Bacl Center
Bed]Trench Edges
1�'
Topsoil
Yes El No
y
COMMENTS: (Include code discrepencies persons present, etc Inspection #1
Location: 1446 25TH ST
1 1 Alt BM Description
2 ) Bldg sewer length
- amount of cover
Plan revision RequiredL? Yes No
Use other side for additional information
SBD-6710 (R 3/97) Date Inseactors Signature
Inspection #2
LjCan No