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Wisconsin Department of Commerce <br /> Safety and Buildings Division ATE SEWAGE SYSTEM county: <br /> INSPECTION REPORT .&-(rne4 <br /> GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No: `� <br /> Personal information you provice may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Sp G <br /> Permit Holder's N me: ❑ City ❑ Village Town of: State Plan ID No.: <br /> a Ve a� e e- 7�197 <br /> CST BM Elev.: Insp. M Elev.: BM Description: Parcel Tax No.: <br /> S�'rne lob.y8 0 0 u' - dost <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. <br /> Septic lK c nic ® BenchmarkRP <br /> Dosing <br /> Aeration Bldg.Sewer 3�� �jyr,1 a g Sip <br /> Holding St/Ht Inlet ,' 9Q,73 <br /> TANK SETBACK INFORMATION St/Ht Outlet <br /> TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet <br /> Air Intake <br /> Septic f, to(y NA Dt Bottom 06,�3 <br /> Dosing 0b-__ �j� �S NA Header/Man. Jr`� e-1148, S r <br /> Aeration NA Dist. Pipe 98 96 <br /> e <br /> Holding Bot.System ,021 <br /> PUMP/SIPHON INFORMATION Fina[ Grade <br /> y <br /> 'a Manufacturer c�1�6YYfA', Demand <br /> Model Number SLID— 5UGPM <br /> TDH I Lift 1, Q Frictioni�'� System�5 TDHLoss �66 <br /> ea <br /> Forcemain Length Dia. hhff it Dist To well <br /> SOIL ABSORPTION SYSTEM <br /> BED/TRENCH Width Length No.O Trenches PIT No.Of Pits Inside Dia. Liquid Depth <br /> DIMENSIONSDIMENSIONS <br /> SYSTEM TO P/L BLDG I WELL LAKE/STREAM LEACHING Manu acturer: <br /> SETBACK CHAMBER <br /> INFORMATION TypeO j 7�a� -_7/001 yb OR UNIT Moe Number: <br /> System: (1 <br /> DISTRIBUTION SYSTEM <br /> Header/Manifold Distribution Pipe(s) ( x Hole Size x Hole Spacing Vent To Air Intake <br /> Length Dia a k Length Dia. ' /( Spacing <br /> SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only <br /> Depth Over Depth Over xx Depth Of �f xx Seeded/Sodded xx Mulched <br /> Bed/Trench Center Bed/Trench Edges 1-�q� Topsoil / *Yes ❑ No ❑ Yes ❑ No <br /> COMMENTS: <br /> (Inc[ code discrepancies, persons present, `� ��s/�/W� _qldecd //J,6�ic� <br /> W� � f m T�� °, /wr /krni?G J71G�t�a <br /> a <br /> rJey #,64 'o,qs e+ D(c <br /> �i,//�r CW A Cu�vc�Q <br /> ni Lal7el 6711, 4,44 <br /> s, <br /> Z10Ile44 ,4 eek w /N� <br /> Plan revision required? ❑ Yes WNci <br /> Use other side for additional information. 3g3 �D <br /> SBD-6710(R.3/97) Date Inspector's Signature Cert No <br />