HomeMy WebLinkAbout020-1489-00-260Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No.
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No 631202
Personal information you provide may be used for secondary purposes IPnvacy Law, s 15 04 (1)(mp
Permit Holders Name City Village Township Parcel Tax No
Kernon J Bast TOWN OF HUDSON 020-1489-00-260
CST BM Elev Insp. BM Elev BM Description SeckoNTownlRange/Map No
lDo 1 Te,4kii tli 10.29.19.3129
TANK INFORMATION - ELEVATION DATA
TYPE
MANUFACT RER
CAPACITY
Septic
i CStC !J G• 5 r
Z5�
Aeration
Holding
TANK SETBACK INFORMATION Z- JZ d- (ACAlk C 1
TANK TO
P/ `t
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
5
Z 7
r• y r
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
G
Model Nu her
TDH
Lift
Fncho Loss
System He
TDH Ft
Forcemal
Length
Dist. to Wi
STATION
BS
HI
FS
ELEV
Benchmark
1. d
ivl. 6
/Dd
All BMj�l iU' (o r
3•
/OrZ
Bldg. Sewer
1.71
/ 89
st/HtInlet
1.15
9/• 45
SUHt Outlet
f6. `47
11- 13
Dt Inlet
Dt Bottom
Header/Man
10.C15
9cr to
Dist Pipe
0.15
g49.65
Bot System
1!•R
8Y•r,5
Final Grade
S.o
9G.{o
St Cover �r /_
3.4
SOIL ABSORPTION SYSTEM ZZ - f Z v:3
BED/TRENCH Width • Length _D • No. Of Trenches PIT DIMENSIONS 1N. Of Pits Inside Da IlLiculd Depth
DIMENSIONS /G Z
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer T� /t• 1 �'
INFORMATION CHAMBER OR 1 Y
Type Of System I r � I 4 t
c � r y 5 UNIT Model Number din l^�n Q �� V1
DISTRIBUTION SYSTEM
Header/M nifold It
1
Length � Dia
Distribution
Pipets)
Length Dia Spacmg
xHole Size
Ix Hole Spacing
Ve7t to�A�ir�IryJ,�ke
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Bedrirench Center
r
S. 6 — G
v
Depth Over
Bedrrrench Edges
> / -Z ..
xx Depth of
Topsoil
xx Seeded/Soddetl
xx Mulched
Vey _- No
[] Yes _� No
COMMENTS: (Include code discrepencies, persons present, etc) Inspection #1: Inspection #2:
Location: 665 EDNA DRr' _ 0q l _ 0"
1 ) Alt By Description = Fi I4r COV`�il �J'$
2.) Bldg sewer length = 7 x
- amount of cover = i t12 r �//1
Plan revision Required? ❑Yes No f /3 1 — /✓��� 3 ,�
Use other side for additionalinfonnan2-1 on ✓ �-4i5•._.
SBD-671 0 (R.3/97) Date Insepctors Signature Can No.
AS