HomeMy WebLinkAbout026-1306-00-038Wscomstn Cepartment of Commerce
PRIVATE SEWAGE SYSTEM
County St. Croix
Safety and Building Division
INSPECTION REPORT
Sanitary Permit No
GENERAL INFORMATION
(ATTACH TO PERMIT)
State Plan 10 No
Personal information you provide may be used for secondary purposes (Privacy Law s 15 04 (1 um)]
Permit Holder's I
ilage To,,nship
7.70 Ta,< No
Joann & Brad Carter
TOWN OF RICHMOND]
026-1306-00-038
ICST BM Elev, Insp BM Day
IBPA Descrotion
I
- ----- i.-- —
TANK INFORMATION
Holding
TANK SETBACK INFORMATION
TANK TO
P�L
VVELL
BLDG
/ant to Air intake
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
7177T7777
tem Head
TDH Ft
th
Dia
Dist to O.'oll
SOIL ABSORPTION SYSTEM
ELEVATION DATA
STATION
BS
HI
FS
ELEV
Benchmark
Alt BM
Bldg. Sewer
St/Ht Inlet
SVHt Outlet
Dt Inlet
Dt Bottom
Header/Man
Dist. Pipe
Bot System
Final Grade
St Cover
BED/TRENCH
DIMENSIONS
VVIdth
Length
I
No Trenothes
PIT DIMENSIONS
No Of Pits
Inside Dia
Liquid Depth
I
SETBACK
INFORMATION
SYSTEM TO
P�L
IBLDG
JVVELL
LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer
Type Of System
lAod.1 Number
i I I I I � Y ZI I tPA
Header'Manbold
Hole Size
Hole Spacing
Ven
iLength_
IlDistril
Pipets)
1�
ix
Dia_
Length_ Me Spec ng_
OUIL LUVI x Pressurp Cable nr At-r—A. n,du
Depth Over
Depth Over
01
C9I of
Seeped'Sodded
Mulched
Bed Trench Center
Bed Trench Edges
",
Topsoil
F709
L
Yes E No
Yes F I No]
COMMENTS: (include code discrepancies, persons present etc Inspection #1
Location: 1513 96TH ST
1.) Alt BM Description
2 ) Bldg sewer length
- amount of cover
Plan revision Required? Yes No i I
Use other side for additional information I
SBD-6710 (R 31971 Insepctor's Signature
Inspection #2
Carl No