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09/29/2008 12:32 3492166 B C ZONING PAGE 01 <br /> _99 0,30 <br /> Wisconsin Department of Commerce <br /> SidW w4 Buildings Dhdslon PRIV TE SEWAGE SYSTEM ounty: <br /> INSPECTION REPORT ( a3 <br /> GENERAL INFORMATION (ATTACH TO PERMIT) Sankary Permitit N^^Ot/jt))�O <br /> Personal information you provice may be used for seconder"purposes[PdvaCy ,S,1S.04(t)(m)1- <br /> FCST <br /> TElev- <br /> el ny VI age Town tatePlan Q NO,! <br /> B E�� BM De r 100 <br /> Parcel T� <br /> MS No.:Old '/da7-la-7D <br /> TAN INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAbACITYSTATION 65 HI FS ELEV. <br /> Septic S �' BenchmarkA7 �Q , O� <br /> DosingNID <br /> ,,�1f <br /> Aeration Bldg.Sewer <br /> Holding St/Ht Inlet <br /> TANK SETBACK INFORMATION St/Ht Outlet <br /> TANKTO P/L WELL BLDG. verdto ke ROAD Dt Inlet �'l1 <br /> Airinta <br /> Septic `q• -2Q A- NA Dt Bottom ,9 973/ <br /> Dosing a8� age >35 NA Header/Man. <br /> Aeration NA Dist.Pipe Q <br /> Holding Bot.System fg,(p 0 <br /> PUMP/SIPHON INFORMATION Final Grade <br /> Manufacturer wa. Demand <br /> Model Number f f GPM 3 CQ IF .�3 ®�- <br /> TDH Lift 33 Frictiorg3S 5 Ste fr TDH�6/ t bQd— <br /> Forcemain Length rf Dia. It one to weu ,3b� d ,j"„SOIL ABSORPTION ABSORPTION SYSTEM <br /> RED/TRENCH Width q Length No.O ren[hes PIT DIMENS q71No.Ol Pits Inside Dle, Liquid depth <br /> num , <br /> INFORMATION <br /> SETBACK <br /> SYSTEM TO P/L BLDG WELL L4K STREAM LEACHING Manufacturer <br /> INFORMATION Type 1d 'i > CHAMBER M-0 a Num ec <br /> System: OR UNIT <br /> DISTRIBUTION SYSTEM A) ij i✓a <br /> Nestler/ e�old D*tnaution Pipes) I p q � x Hole SJze (i x HoO,eSpa6ng vent-To Air Intake <br /> Leagih Dia `._ Leegth Dla. �— Spaon 1 ss <br /> SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only <br /> Depth Over dd Depth Owr xk Depth Of k.seeded Sodded xz Mulchetl <br /> Bed/Trench Center 1, 5 <br /> BedlTrenchEdges �' e 6 TOpspll r SG <br /> M ❑ No ❑ Yes O <br /> COMMENTS: (Include e discrepancies,persons present,etc.) <br /> • r C' <br /> Oontlb plc ��� ,Sewer— Ihsu4f,�Cp� �)774 <br /> Plan revision required! Q Yes _1R:Wo <br /> Use other side for additionalinforma-tfon. 8 y1 9 <br /> 580-6770(R.3/a7) Date f Inspectors Signature Cert.No. <br />