HomeMy WebLinkAbout030-1021-95-100 (2)Wisconsin Department of Commerce
PRIVATE SEWAGE SYSTEM
County
St. Croix
Safety and Building Division
INSPECTION REPORT
Sanitary Permit No
GENERAL INFORMATION
fATTACH TO PERMIT)
SAN-2021-414
State Plan IS N.
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Permit Holder's Name
Dave Waldroff
City Village Tovnsh,p
I 1
Parcel Tal No
TOWN OF SAINT JOSEPH
030-1021-95-100
TANK INFORMATION
TYPE
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG
\/ant to Air intake
ROAD
Septic
Dosing
Aeration
Holding
PUMPISIPHON INFORMATION
Loss
bi Abb(JKPTION SYSTEM
ELEVATION DATA
Dt B(
Inlet
T� 71 e-t
Pipe
St Cover
BS
BEDfTRENCH
DIMENSIONS
Alum
Length
I
No 0 Trenches
PIT DIMENSIONS
No Of Pi
ide Did
Liquid Depth
I
SETBACK
INFORMATION
SYSTEM TO
PIL
BLDG
JVVELL
LAKEISTREAM
LEACHING
CHAMBEROR
UNIT
Manufacturer
Type Of System
Model Number
LJI,j I Irl I IUN byb I trvi
HeaderfManifold
D�atrilbution
Hole Sise
Hole Spacing
Vent to Air Intake ----
P de(a)
I
Length Did—
Leri Did_ Spacuri
ouiiL -,L)vEK . Prdhi,;uu,.lgv.t.ni rhol� vv U--A cl� A. c—�- 0 �-1
Depth C,er
Depth Over
Depth of
SeedediSodded
Muliched
Bed/Trench Center
BedlTrench Edges
To
1� psod
F1 Yes I—] No
F-1 Y
COMMENTS: (Include code discrepericies, persons present, etc) Inspection#1
Location: 1160 TROUT BROOK RD N
1 ) Alt BM Description
2) Bldg sewer length
- amount of cover
Plan revision Required? E] Yes D No
Use other side for additional information
SBD-6710 (R 3/97�
Inspection #2