HomeMy WebLinkAbout020-1489-00-160Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
(ATTACH TO PERMIT) 631253
GENERAL INFORMATION state Plan ID No
Personal Information you provide may be used for secondary purposes [Pnvacy Law, s 15 04 (1)(m)]
Perinit Holdefs Name Village Township Parcel Tax No
Qty'.
Kernon Bast TOWN OF HUDSON 020-1489-00-160
CST BM Flay / Insp BM Elev BM Description SectionrrownfRange7Map No
gtyl+ 10.29.19.3119
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
/ CAPACITY
-d
Septic
r n
1(p lip
Dosi
I
L7 w Qo aiL
Ae aI
Hold/igg-
TANK SETBACK INFORMATION
M®Mm®w
®m
r
mm�
_=�
=
gym
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model Numb
TDH
Lift
nction Loss
System Head
TDH Ft
Forcemam
Length
t to
SOIL ABSORPTION SYSTEM
DISTRIBUTION SYSTEM
STATION
HI
FS
Benc
Cjrhl mark colTI63
`BS
5•o
iC
gELLEVV
/r` 1"
Alt BM
Bldg. Sewer
SNHt Inlet
$ &0
D /
SUHt Outlet
S. V
Of Inlet
/
Dt Bottom
/
Header/Man
1
Dist. Pipe
Bot System
10 ID
D 10
ID.1
Final Grade
he4e
•01
r
St Cover
CHAMBER OR
UNIT
Head
N
Dlstnbution
PI s
x Hole Size
z Hole S
Vent to Air Intake /
Length OIa
Length
Dia
Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
Bed/Trench Center
Bed77rench Edges
Topsail
Yes ❑ No
0 Yes [INe
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1. 10�3/ ZoZ Inspection #2.
Location: 1066 HOPKINS DR 6> P�U.w.'1Y er*, tCpV
1.) Alt BM Description - f
2.) Bldg sewer length = ) .�' - a SB( �NC
amount of cover Ztf 5;40L&e-t
�1
.
3) 3,Sa ivt, kO.VA.414erfe t vMovl � 2Qa�mn� r
f
Plan revision Required? ❑ Yes Iy�'� No 0 /
r sid foraddni I informal`?? l��) pt��(�O$��� (�I�Q�T[pA qy�� �y
so
(R 3H7) U'� Cent. No
5) `� QAYc.� �nrf�%r«ck RQ�.u,lye�� lv2w Q