Laserfiche WebLink
'Dues. 2- i0- a 3 1 , <br /> Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: <br /> Labor and Humgn Relations INSPECTION REPORT <br /> Safety and Buildings Division <br /> (ATTACH TO PERMIT) Sanitary Permit No <br /> GENERAL INFORMATION aO)g <br /> Perm't Holder's Name ❑ City ❑ VillageTown of State Plan ID No.: <br /> CST BM Elev : Insp.BM Elev.: BM Descnpti n: ^ Parcel Tax No.: <br /> S�'J�711/ ,56 a%�A� ae,� — M—ROO <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER L CAPACITY STATION BS HI FS ELEV. <br /> Septic �S� C'we I e 7�0 Benchmark6 <br /> �J' <br /> Dosing <br /> Aeration Bldg.Sewer <br /> Holding St/Ht Inlet (a <br /> TANK SETBACK INFORMATION St/Ht Outlet ._�e Inv I8 <br /> TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet <br /> Air Intake <br /> Septic >��� 3� N NA Dt Bottom <br /> Dosing NA Header/Man. <br /> Aeration NA Dist. Pipe G,5- <br /> Holding Bot.System 6 a0 <br /> PUMP/ SIPHON INFORMATION Final Grade �j_ 'Isa6 <br /> Manufacturer Demand <br /> Model Number GPM !Y fjAtL/ „ ' Od <br /> TDH Lift Lriction System oss TDH Ft 4naY-,,.'�Lih ?� 95,,33 <br /> ead <br /> Forcemain Length Dia. H Dist Tovell <br /> SOIL ABSORPTION SYSTEM <br /> BED/TRENCH width / Length f No Of T enc PIT No Of Pits Inside Dia. Liquid Depth <br /> DIMEN SIONS DIMENSIONS <br /> SYSTEM TO Pa WELL LAKE/STREAM LEACHING Manufacturer: <br /> SETBACK CHAMBER <br /> INFORMATION TypeO / Mode Number: <br /> System: >/�0' � U 3� OR UNIT <br /> DISTRIBUTION SYSTEM <br /> Header/Manifold Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake <br /> Length _ l Dia. Length / Dia y Spacmg &- <br /> SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only <br /> Depth Over Depth Over xx Depth Of xx Seeded/Sodded xx Mulched <br /> Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No <br /> COMMENTS: (Include code discrepancies, persons present,etc.) p� <br /> Per�irposf�( < S f" ` z� <br /> Plan revision required? ❑ Yes ((No Q I` G <br /> Use other side for additional information. C3 <br /> SBD-6710(R 05/91) Date Inspector's Signature Cert.No. <br />