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HomeMy WebLinkAbout040-1052-40-000 s Form - S '1' C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER/? t TOWNSHIP SEC. T N-R W ADDRESS i C 3 S ST, CROIX COUNTY, WISCONSIN l(C SUBDIVISION LOT LOT SIZE ) %r`G `o PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~t Itoo 5~• 7o rn 1AJ C_ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation C,f vertical reference point: f SGird rd e" Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: , 0C)o Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation:f Tank Outlet Elevation: Number of feet from nearest Road: Front,0 Side,O Rear, O feet From nearest property line Fr_ont,0 Side, Rear, 0 / ; feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE luLVEPSE S! nr PUMP CHAMBER C N Liquid Capacity: Q©~} )~'q Manufacturer: Pump Model: pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Gallons per cycle: Pump off switch elevation: Alarm Switch Type: Alarm Manufacturer: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: - Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ° Trench: r Width: Length:--( Number of Lines: .3 Area Built: _ g T Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: _ Elevation of bottom of tank: _ Elevation of inlet: Side, 0 Rear, O Ft. Number of feet from nearest property line: Front, O Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: ~ Plumber on job: Number: O31 3/84:mj