HomeMy WebLinkAbout020-1411-01-000 (2)Wisconsin 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, s 15 04 (1 )(m)]
stin SChoeoke
Description
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
CX sir
�Opt7
Dosing
Aeration
Holding
TANK SETBACK INFORMATION Co,p{(�, �Cto n,
®�IM�A-
®.-„-I-,_-
-
®"--_�=
PUMP/SIPHON INFORMATION
Manufacturer
Demand
M
Model N
tuber
I
TDH
Li
Z
Frictio Loss
1
System ead
TDH Ft
Forcema
Length
ia.
Dist. ow -
SOIL ABSORPTION SYSTEM
TOWN OF HUDSON
TION DATA
County St. Croix
Sanitary Permit No
SAN-2020-401
State Plan ID No.
Parcel Tax No
020-1411-01-000
Section/Town/Range/Map No:
13.29.19.2571
STATION
BS
HI
FS
ELEV.
Benchmark
Alt BM
Bldg. Sewer
y, z
It7o.7�
SUM Inlet
�l
SUHt Outlet
Dt Inlet
Dt Bottom
Header/Man.
Dist. Pipe
Bot. System
Final Grade
St Cover
BEOrFRENCH
Width
Length
No Of Trenches
PIT DIMENSIONS
No Of Pits
Inside Dia.
Liquid Depth
DIMENSIONS
SETBACK
SYSTEM TO
P/L
BLDG
WELL
LAKE/STREAM
LEACHING
Manufacturer
INFORMATION
CHAMBER OR
Type Of tern
�S �l
)
UNIT
Model Number
DISTRIBUTION SYSTEM J
Header/Manifold
}}��t� `��-
IDIstnbution
Pipe(s)
x Hole Size
x Hole Spacing
Vent to Air Intake
Length /��1a]a
Length Dia Spacing
SOIL COVER ✓ x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Bed/Trenc
r��tter.
y
t
I
Depth Over
Bed/Trench Edges
xx Depth of
Topsoil
xx Seeded/Sodded
❑ Yes
❑ No
xx Mulched
❑ Ves
❑ No
COMMENTS: (Includalde discrepencies, persons present, etc.) Inspection #1
S 1' 11 Inspection #2:
Location: 942 ALEXANDER RD —
l rwrr %je (vh��r� un7��
1.) Alt BM Description = h' o hit t 5 ( o ,�y
2.) Bldg sewer length = 85 ` ' ,� L �`L • / b n ��-e T"�7"ri o/o w n . Bvr JJ (r 5
-amount of cover => iZn M• P rer)r/
Plan revision Required? El Yes y No ?
Use other side for additional Informati /
Date Insepctor's Signature Cart No