HomeMy WebLinkAbout020-1418-70-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Butltlmg 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)]
Permit Holder's Name City Village Township
Nick & Amber Jepperson TOWN OF HUDSON
CST BM Elev Insp BM Elev BM Descriptionto I- 91 ; 11
TANK INFORMATION ELEVATION DATA
TYPE
MANUFAC
URER 1J�
CAPACITY
Septic
F
gC
vl I o 57-5
Aeration
Holding
TANK SETBACK INFORMATION Li �- CIii
TANK TO
P 2I
WELL
BLDG
Vent to Air Intake
ROAD
Septic
7 Z
Dosing
Aeration
Holding
PUMPISIPHON INFORMATION
Manufacturer
Demand
GPM
4an
action Los
ystem H ad
TDH Ft
th
Di
1
Dist 171
SOIL ABSORPTION SYSTEM
STATION
BS
HI
FS
ELEV
Benchmark
5 r-7
1 d7.
f 0l
Alt BM
Corer
5.3
l o Z
Bldg Sewer
7—
O
9s.
SIJHt Inlet
9.3
I/Ht Outlet
Dt Inlet
Dt Bottom
Header(Man
Dist Pipe
q Q�
'rT�
Bot ,je
O
q7,
/ (9,'l
Final Grade
St Cover
7 7_ + 7 Z CAn Li- rC
BED/TRENCH
DIMENSIONS
Widtht
Length t
No Of Trenches
2-
PIT DIMENSIONS
No Of Pits
Inside Die
Liquid 0
SETBACK
INFORMATION
SYSTEM TO
P!L
BLDG
WELL
LAKEISTREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer
Yl'4-1 rOt r
Type Of System
Cvtow
O
`tit
V
ze `
L (J
r'
' 1J0�
Model Number
1 C.�
UIS I RICO I IUN SYSTEM
Hesperia fold 1
/ 4 (� x
Length l0 Die !
Distnbuhon
Pipe(sl
x Hole Size
x Hol
Vent to Air 1t_ake
clka Yt'14(,l LAe
Length Cie Spacing
SUIL GUVER x Pressure Svsfems Only xx Mnund Or Gt.r:rado sysrem� nnly
Depth Over 1 ' t
Bed7rench Center �^ L� L
Depth Over
Bed.Trench Edges > ) 2— tt
xx Depth of
Topsoi
xx Seeds
'L Yes _ No
Ves _ No
COMMENTS: (Include code discrepancies, persons present. etc) Inspection #1 i Inspection #2
Location: 848 DORWIN RD II / — y'C1,^l
1 ) Alt BM Description 1h Lowe- h a ✓1 t,
2 ) Bldg sewer length = t Iv L 1 —M, ) Ins Q10 L�) �•I
-amount of cover=7�$•' ({/
Plan revision Required? ❑Yes i No / Z 1 L
Use other side for additional information,\ (9 r
SBD-6710 (R 3197) Date Insepctor's Si nature
III t ��3
Cert No
WA