HomeMy WebLinkAbout030-1043-50-000Wisconsin Department of Commerce
PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION
(ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, a 15 04 (1)(m)]
Permit Holder's Name
City Village Township
Cale & Abbie Dahm
TOWN OF SAINT JOSEPH
CST BM Elev:
rT�
IBM Description,
TANK INFORMATION
ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
PUMP/SIPHON INFORMATION
I TDH 11-ift lFriction Loss I System Head I F�
lForcemain ILencith IDia. Dist.toWell ff
SOIL ABSORPTION SYSTEM
BEDrri Length
H lWidth o. Of Trenches
DIMENSIONS I AV
INFORMATION
County St. Croix
Sanitary Permit No:
617758
State Plan ID No
Parc I Tax No,
030-1043-50-000
Section/Town/Range;Map No
I 20.30.19.158G
St?W Outlet
MAN il EMKT#
imm
'VAWWMSIM�
WBEROR
UNIT
A
z
HeaderlManifold
tic
x Hole Size
Hole Spacing
ii-ength
P!.m(b
ID P. s)l
I \1
ix
Dia
_ D _ Spacing_
SOIL COVER x Pressure Systems Only xx Mound Or At-Grad(IS)illitems Only r 11 4111111l
Depth Over
Depth Over
Depth of
Mulched
Bed/Trench Center
I
Bed/Trench Edges
I
Topsoil
I- ,Ved1Sodded$,
a Nw
1xx
Y. No
El s7
COMMENTS: (include code discrepancies, persons present, etc.) Inspection #1. Inspection #2:
Location: 1426 E OAKS TR
1.) Alt BM Description
2.) Bldg sewer length
- amount of cover
Plan revision Required? F-1 Yes ��] No
Use other side for additional information. L
Date
SBD-6710 (R 3197)
Insepctors Signature
Cen No.