HomeMy WebLinkAbout042-1077-20-300Wisconsin Depanment of Commerce PRIVATE SEWAGE SYSTEM
Safety and Gutting Dimsion
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Pnvacv Law, 5 15 04 (1 i(m)]
ANK IM-ORMATION
Septic
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG
\lent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
GPM
Model Number
D H EL, Friction Loss System Head TDH Ft
F""_.,rr7Le., th Dia Dist to',Veif
SOIL ABSORPTION SYSTEM
ELEVATION DATA
ISM
] Sewer
It Inlet
Pipe
St Cover
ELE—V
BEDrTIRENCH
DIMENSIONS
Wduh
I Length ---T
Of Trenches
PIT DIMENSIONS
INC Of 77-1
Inside Did
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
IP/L
IBLDG
1WELL
�L�AKE/STREA
LEACHING
CHAMBER OR
UNIT
Manufacturer
Type Of System
I
I
L
__EjM
I Moder Number
Ula 1 111101.1 1 JUN Z)Yb I tM
Header/Mamrfdd
ID,Str,but,.n
Hole Size
777� —pading
Vent to Air Intake
iLength_
Dia _
jPIpe(s)-
Length Did Spacing
olvJn� kovvam x Pressurna Siastarna 0.1,, .. Mnuund In, Af.rr.d. n.1
Depth Over
Depth Over
Depto of
Seeded Sodded
Mulched
B.d,Trench Center
Be&Trench Edges
To
1� pscu
7
Ll Yes �:] No
E] Yes
COMMENTS: (Include code discrepancies, persons present etc I Inspection #1
Location: 770 112TH ST
1 ) Alt BM Description
2 1 Bldg sewer length
- amount of cover
Plan revision Required? Yes ' I [
L ] No
Use other side for additional information
SBD-6710 iR 3197) Date Insei Signature
Inspection #2,
Cert No