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<br /> Wisconsin Department of Industr ' • VATE SEWAGE SYSTEM Cou ty:
<br /> Labor and Human Relations S "L-C�"t NSPECTION REPORT
<br /> Safety and Buildings Divisio 1.J✓�. ��i Sanitary i> o.:
<br /> GENERAL INFORMA • , (ATTACH TO PERMIT)
<br /> ,,- .S-..5--Z,
<br /> Permit+older's Name: ❑ City ❑ Village Town of: State Plan ID No.:
<br /> •• IZEiL"r 34-=•//1-4714/ -S,-.1 -Pr- 9,5--n4/a
<br /> CST BM Elev.: Insp.BM Elev.: BM Description: 7 Parcel Tax No.:
<br /> -16C}f 6 ,2U= ((x::` r -r7Ml ,. s /r-orio -�4 , -- -
<br /> TANK INFORMATION ELEVATION DATA
<br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
<br /> Septic 1 _2),rx Livt ?7 Benchmark 6r9b lgjG '
<br /> Dosing La c /17 FO
<br /> � ' s60'
<br /> A7k3itas" thus SC��_�� "c-zc�-- '[�� Bldg.Sewer �?�7S (7-,.i� ��,la
<br /> Holding St Ht Inlet //i5 C1,5,5-5-/
<br /> TANK SETBACK INFORMATION St Ht Outlet It,Zt 95. g9 4
<br /> Vent to i
<br /> TANK TO P/L WELL BLDG. Air Intake ROAD Dt Inlet
<br /> Septic Ai,Y-- NA Dt Bottom v,,� 41":33 l i 9427 /
<br /> Dosing > ' ...›.;2 i 5 5' >/b/ NA Header/Man. j:) So)C g,9t,' 9 g,on/
<br /> 2� ' >2 SS ' iV o4- p r p( p 31 I1 /,.2r/ 97 tic/ ,
<br /> Aerat NA Dist.Pi e
<br /> Hol Bot.System c-4r) /, 3/ 9 39 9 i
<br /> PUMP], IPHON INFORMATION Final Grade /
<br /> �7r�r /v,s4 9�,.fy a
<br /> Manufacturer ,I,,I,I�--... Demand / _ /ad q6.Co'
<br /> Model Number
<br /> C-1,6-- JCS GPM 44 Jo,1,5- 9'6 j
<br /> TDH Lift Friction WIT/4 TDH Ft Lei+'(, 1 L`1O/ ?SS
<br /> Forcemain Length 9s/ Dia. ' Dist.To Well>Ic' �..ec.11 )0 S'41- �`y'��O -
<br /> SOIL ION SYSTEM 77/ft. l , lc' (y1,4 es,
<br /> BED RENCH idth Length , i No.Of Trenches PIT No.Of Pits _Inside Dia. Liquid Dep
<br /> DIME S-- ,','U -- DIMENSIONS
<br /> SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING nufactu r: ,
<br /> SETBACK CHAMBER
<br /> INFORMATION Type Of i i j Modef'Num er:
<br /> _ System -E.�,4 S?.Z ,�Z5' /0&.. OR UNIT
<br /> DISTRIBUTION SYSTEM ?ip'
<br /> Header/ anif l / Distribution Pi e((s7)/ xH a Si e x Ho a Spacing Vent To Air Intake
<br /> Length }G I Length '/ Dia. Spacing /"• Iret-e_i I inF I �/0
<br /> SOIL COVER / x Pressure Systems Only xx Mound Or At-Grade Systems Only
<br /> // !.r xx Dept .OL___-... xx-Seeded/Sodded xx MuTcfits'tl'•---+
<br /> Dept r' // Depth //�//
<br /> Bed/ rent enter Li al Bed/ ren Edges ""/,72 Topsoil • Yes ❑ No1 -r]-Yes-_ No
<br /> CO ENTS: (Include ode di crepar�cies,persons present etc.) a',.9 2,..SP€`Z'�r,� O i,
<br /> ,1t�.J 2F�F .)iC3 .,,,-.Fr F,,e5/c/ 5.6-. jcss—r-e 14 -r; -.WA .` ' . ,
<br /> P Pc &( lZ_3Jo rr o
<br /> SY ,;29fc,J r z ta--t" cou7 I L,S
<br /> E.„„,,,...t.,N P7,,,$ i\APqL.sorq . ______/- f, - 4 af-aks_ '
<br /> Plan revision required? ❑ Yb �6 Use other side for additional inf A ' .rhiSritligler■
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<br /> SBD-6710(R 05/91) Date ns••ctorVignature Cert.No.
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