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Home My WebLink About020-1495-27-000Wsconsm Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal Information you provide may be used for secondary purposes IPnvacy Law s 15 04 (1)(m)] Permit Holder's Name Gty Village Township Urchins LLC TOWN OF HUDSON CST BM Eiev I Inso BM Be, IBM Description TANK INFORMATION 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 Llft Friction Loss System Head TDH Ft Forcemain Length Dia Dist to well SOIL ABSORPTION SYSTEM ELEVATION DATA St Cover an. FS BED/TRENCH DIMENSIONS '✓Jidih Length No Of Trenches PIT DIMENSIONS No Of Pits Inside Did Liquid Depth SETBACK INFORMATION SYSTEM TO P/L IBLDG IWELL ILAKE,STREAM LEACHING CHAMBER OR UNIT Manufacturer Type Gf System Model Number UIJ I KI[SU I IUN SYS I LM Header Manifold Distribution x Hole Sae x Hole Spacing vent to Air Intake Pipelsl Length Dia Length Dia Spacing SOIL GUvtK x Pressure Svstams Only xx Mnimrl nr Arr.nrade s.eteme nnl, Depth Over Depth Over a Depth of Seeded Sodded xx %lurched RedTrench Center BedlTrench Edges Topsoilxx — _ _ ❑ Yes _ Na yes No COMMENTS: (Include code discrepencies, persons present. etc) Inspection #1 Location: No Address Available 1 ) Alt BM Description = 2 ) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes r i No Use other side for additional information I �I _ SBD-6710 (R 3197) - Data Insepctor's Signature Inspection #2 -1 LJ L- - Cert No