HomeMy WebLinkAbout040-1322-03-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county St. Croix
Safely and Building Division
INSPECTION REPORT Sanitary Permit No
(ATTACH TO PERMIT) 644775
GENERAL INFORMATION State���Pla{n ID No
Personal information you provide may be used for secondary purposes[Privacy Law s 15 04(1)(m)) PW t — I O Zta ZSR)-_
Permit Holders Name City Village Township Parcel Tax No
Brian R. & Stephanie A. Sherry TOWN OF TROY 040-1322-03-000
CST BM Elev. I Inv BM Elev. ( BM Description Section/Town/Range/Map No
leO .a Ioo o , Ctr b 19.28.19.2167
TANK INFORMATION / ELEVATION DATA
TYPE E � SURE CAPACITY STATION BS HI FS ELEV.
Septic iii (/cC'n /� Benchmark ( 4)3sOv3 )
#1754) , D ,
Dosing L�,. / ) ,i Alt BM
a
Aeration Bldg. Sewer 12bZ /
Holding St/Ht Inlet i•• r
St/HI Outlet
TANK SETBACK INFORMATION
TANK TO '' IIP,/L /WELL BLDG. Vent to Air Intake ROAD Dt Inlet sL
Septic "f`r1 l �� 181 r Dt Bottom 1`� ! 1�' mil'/ 'y` I} Z �]i_ fps e
Q 7S / 'j 1 lrz3 ` t 517 rCJ
Dosing I r tt tr 7p y Header/Man. `T / Cl� / ,
7 2r D ,
Aeration Dist.Pipe
Holding .....› ._ Bol Sstem g 2 /O/ (O.
I3. S Iao, 82
F" al Grade rI
PUMP/SIPHON INFORMATION ( (ye et/Z.fi5
Manufacturer _ Q Q Demand1 y S Cover ! J St 2 r 96,3Z
Model Number ` �oS 32• I ' C T/t,,,r (I. 1/S11[/1t1�► `Nig 1
TDH Lift i Friction Lost 1 System Head TDIJ S FI r L LI( t / )- } 113 o r 'a
1`t Al. 3az� 3 9 V wt "1 "11
Forcemain Length I �Dia.
2 III Dist to Well ( )
Ve
SOIL ABSORPTION SYSTEM
dt / Length_ I No Of PIT DIMENSIONS No Of Pits Inside Dia. Liquid Depth
EN Wr / ' r a 1 !
SETBACK SYSTEM TO /P/L rlY..r) BLDG WELL LAKE/STREAM LEACHING Manufacture) �V
e /
INFORMATION CHAMBER OR
TypeOf System /� ( ,r mot, / UNIT Model Number
DISTRIBUTION SYSTEM ` I AS�jis++•
HeaderlMendoltl Distribution (/ f x Hole Sure x Hole Spa cmg / Vent to Air Intake
0fry r ' I II PiPeta) // r � I 2 fD
LengtI J r Dia 1 Length �) ,' Dia I Spacing • r •
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over tut Depth of or Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil _ Yes No • Yes I No
CO51ENT$: (Include��dde discrepencies,persons present,etc.) Inspection#L/ /b� .2. Inspection#2: ' 1 Ijy/2
Location: 378 PEACEA LE HILL RD� y
M( etxH�e f /tt'' >
1 J Alt BM Description= �o
IL
2.)Bldgsewer length=
amount of cover i�'/( /< '� C /f 4 I I f "r7 �a tecCltelt' blre.r V . " - A+! ~ per
I Q- .J tJpup
3�ob .- J 0 i . ;row e..tKe�S �1 • �1I`1��,(�
Use other lside Rfor additional information No nit
T I 1 �!� "�_ "'� ---- S �
Date Insepclor's Signature Cert No
��//SBD-6710Q� (R.3/97) �//t ,-^ / `�'� [��. ,� �J .� /}�
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