HomeMy WebLinkAbout020-1479-14-000 (2)Wisconsin Department of Commerce
Safety and Building Division
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes tPnvacy Law, s 15 04 (1)(ni
Ryan
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
,
S I Yt
I Z4%;>
71
Y
Aeration
Holding
TANK SETBACK INFORMATION
MM.M=�=
ME/=II/LI
on
MV==fir
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model N mber
TDH
ift
Fnctlo Loss
System He d
T H Ft
Forcelrdam
Length
Dia.
Dist to Well
SOIL ABSORPTION SYSTEM
TOWN OF HUDSO
TION DATA
County St. Croix
SanitaryPent No.
617819
Stale Plan ID No
Parcel Tax No.
020-1479-14-000
Secbon/TownlRangertdap No
36.29.19.3035
BEDfTRENCH
DIMENSIONS
Width
Length
G%[
No No Of Trenches
Z
PIT DIMENSIONS
No Of Pits
Inside Dia
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/f&QjBLDG
IWELL
LAKEISTREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer
A-/V
T e Of SyS t
` x
6
\�O
_—
Model Number 0%r
DISTRIBUTION SYSTEM
Header/Manifold JOistribution
/� t
Length la Dia `T
Pipes)
Length Dia Spacing
x Hole Size
x Hale Spacing
Vent to Air Intake
/ 11
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Bedfrrench Center 7 8
Depth Over I I`
BedfTrench Edges / 1 Z
xx Depth of
TopsoA
xx Seeded/Sodded
InMulched
Yes I ] No
J es o
COMMENTS: (Include code discrepencies, persons present, etc.)
Location: 604 SCHWALEN DR /
1.) Alt BM Description = / C�t${-r rt , VkaPt A0
2) Bldg sewer length
_ amount of cover
Plan revision Required? ] Yes _ No
Use other side for additional information.
Date
SBD-6710 (R 197)
,e t Al
Inspection #1: OAT% Inspection #2 r
_ NO QddrbUvrq / Goyrr QllouAed 1
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-iofl e'f velf". =Ib•3---IL-
c JL� v I S-4/
In sepctors Signature Con No