HomeMy WebLinkAbout020-1404-03-000 (2)Wisconsin Department of Commerce
Safety and Budding Division
GENERAL INFORMATION
Personal information you provide may be used for secondary purposes
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
Law s 15 04 (1)(m)j
City village TOTownWhip
N OF HUDSON
Todd & Kimberl Osterhues
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
1,1 . /' ✓
Vv (i
70
Aerau
Holdl
TANK SETBACK INFORMATION
TANK TO I P/L I WELL I BLDG I vent to Air Intake ROAD
luusing I '>i ��fl 36/ 1 ys' 1 1
PUMPISIPHON INFORMATION
Manufacturer I I
Model Number R'V S _ '- D rJ'"
TDH Lift Friction Loss System Head TDi Ft
Forcemam 11 - thh 1 L�, Dia /� Dist to vvel 1
SOIL (ABSORPTION SYSTEM ( I L�-) /
ELEVATION DATA
Nam E14611
SI/Ht Outlet
�I�—����iii�
M�'�+
- �_- �
■■ram
.�.
- � �,
_
Man-
ORRMIMM
\ LWM /
RE NCH
DIMENSI INS
Width r
Length No Tr e chas
�� 7
PIT DIMENSIONS
No Of Pots
Inside DoLiquid
Depth
SETBACK
INFORMATION
SYSTEM TO
JP/C
JBI
IWELL
FLAKE/STREAM
LEACHING
CHAMBER OR
LINIT
Type K System
l^.�
5 (
)
v
0�
/
Model Nu r
ula t MIOVI IVP1 a.Tra l rivl I —'Tv r/va-Y 2-/1 r.1. 1
Heatle ani Id
Disinbution
xHole
xH ing
Vent to Air Intake
Lang h
Pipes)
Length
/
> r O0
SUN—GVVI=R x Preseum Svsrwms 0.1v . M,rend n, At-r—A. a„.r— n..t„
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
BediTrench Center
BedlTrench Edges
Topsoil
E] Yes I 1 No
I 1 1 Yes _ No
COMMENTS: (Include code discrepancies persons present, etc ) Inspection #1 (1,IX Inspection #2
Location: 436 JACK PINE DR r.
1.) Alt BM Description =lr.N➢1D
2 1 Bldg sewer length = \' y'�ir�/ (i/•O'P'a.�`p'��('/ `�° ���"��j
-amount of cover =
3) W6-e ,fie III _
Plan revision Rfor ad dv Yes ND � Z }
Use other side for additional Informs ti>� `_ /
SBD-6710 (R 3/97 D e �` Insepctor's Signature C
�) R.
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