HomeMy WebLinkAbout020-1493-10-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safely 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)l
Permit Holder's Name Cdy Village Township
Urchins LLC I TOWN OF HUDSON
CST BM Elev Insp BM Elev BM Description
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
TDH
Lift
Friction Loss
System Head
TDH Ft
For" ,in
Length
Dia.
Dist to Well
SOIL ABSORPTION SYSTEM
County. St. Croix
Sanitary Permit No
633376
Slate Plan ID No
Parcel Tax No
020-1493-10-000
SectionFrown/Range/Map No
35.29.19.3161
STATION
BS
HI
FS
ELEV.
Benchmark
Alt, BM
Bldg, Sewer
SVHt Inlet
SUHt Outlet
Dt Inlet
Dt Bottom
Header/Man.
Dist Pipe
Bet. System
Final Grade
St Cover
BEDITRENCH
Width
Length
No Of Trenches
PR DIMENSIONS
No Of Pits
Inside Dia
Liquid Depth
DIMENSIONS
SETBACK
SYSTEM TO
PA-
BLDG
WELL
LAKE/STREAM
LEACHING
Manufacturer
INFORMATION
CHAMBER OR
UNIT
Type Of System
Model Number
DISTRIBUTION SYSTEM
Header/Manifold
Distribution
x Hole Size
x Hole Spacing
Vent to Air Intake
Pipe(s)
Length Dia
Length Da Spacing
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Oniv
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
Bed/Trench Center
Bed/Trench Edges
Topsotl
—
Yes ❑ No
—]Yes ❑ No
COMMENTS: (Include code discrepenaes, persons present, etc.) Inspection #1:
Location: 740 BENNY CIR
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Regmred9 ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 3197) Date Insepctoes Signature
Inspection #2
Cert No