HomeMy WebLinkAbout020-1481-09-240Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM I
County St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan IDNo 633814
Personal information you provide may be used for secondary purposes [Privacy Law, s 15.04 (t )(m)l
Permit Holders Name City Village Township Parcel Tax No.
Travis & Kaylie Schmidt I TOWN OF HUDSON 020-1481-09-240
CST BM Elev Insp BM Elev BM Des t on Secbonrrown/Range/Map No
I Ar 07.29.19.30671
TANK INFORMATION ,-.&dam 'ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
V"
Dosing
cd�tba
Q
Aeration
Holding
TANK SETBACK INFORMATION ) 9 11A A:- S
TANK TO
P/L
WELL
BLDG.
N h0 J�St
Vent tcAuilhulikEr
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION MnAc-.L A00 ,%1t.1 X
Manufacturer
mand
GPM
Model Number
�- 50
TDH
LI . (,,.I
Fniabon floss
System �lc.%5
IT
OH ��x Ft
/I I
Forcemaiin
Le th
Din. tt
Distt. to Well
SOIL ABSORPTION SYSTEM
STATION
BS
HI
FS
ELEV.
Benchmark
Alt BM
Bldg Sewer
/u
,
SUHt Inlet
I�•O
��'�t
SVHt Outlet
Dt Inlet
Dt Bottom
�•�
90.rj
'']]
HeaderlMan
Dist. Pipe
rJ _$7
/Oo- O
Bot System
Final Grade
C verCall
i ✓
!
/✓ C_
BEDITRENCH
DIMENSIONS
Width gj.1
r�
Len
No O( Trwichms y[L
PIT DIMENSIONS
No Of Pits
Inside Ma
Liquid Depth
SETBACK
SYSTEM TO
P/L 5
BLDG
WELL
LAKE/STREAM
LEACHING
Manufacturer
INFORMATION
Type System
f
,r
rLL'
P
CHAMBER OR
UNIT
Model Number'
DISTRIBUTION SYSTEM tAndnY9'100'
Header/Manifold �t I Y
Distribution
x Hole Size
x Hole Spacing
Vent to Air Intake
Length Dia
Length `�1
3
J
Dia Spacing
I(l�
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Svstems Only r3i.JAla,r�u✓
Depth Ov �
Depth Over
xx Depth oL b
xz Seeded/Sodded
xx Mulched
BedrTre ch Centerr/ j V
BedRrench Edges
Tapsod y
/
�. Yes I_� No
-9H'es
[, Na
COMMENTS: (Include code discrepencies, persons present, etc.)
Location: 1071 AUTUMN OAK LN
1 ) Alt BM Description = c i l }VP
2.) Bldg sewer length
- amount of cover =
Inspection#1. .,)ly ihD q^vz Inspection#2
• Na VJGI
No avi�rr
Id�iti�0 to
zTi
Plan revision Required? ❑Yes [ .No 1 `�N 1 U Use other side for additional information. Il /N _ _
Date a tors Signature Cent. No
SBO-6710 (R.3/g7)
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