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I r <br /> DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY BE BUILDINGS <br /> LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION <br /> P.O.BOX 7969 BUREAU OF PLUMBING <br /> MADISON,WI 53707 <br /> CONVENTIONAL ❑ALTERNATIVE S1111 Plan LD.N„mb­ <br /> IH a„rP„eel <br /> ❑Holding Tarek ❑ In-Ground Pressure ❑Mound <br /> NAME OF PERMIT HOLDER ADDRESS OF FIEFINITT HOLDER. INSPECTION DATE. <br /> ON lv/ S P37 <br /> BENCH MARK IP ens ele,ence Dorms DESCRIBE IF DIFFERENT FROM PLAN I REF.PT.ELEV.. CST REF.PT.ELEV. <br /> 1,6 r y <br /> Nam•o Plumber. MP/MPRSWNE, Cnunly Samlary Permit Numbv <br /> SEPTIC TANK/MBCDTIb-ThIE"i <br /> MANUFACTUR R. ) LIO(IIID CAPACITY TANK INLET ELEV TANKOUTLET ELEV WARNING LABEL LOCKING COVER <br /> ./ /� �; ..(( PROWLED IDES PROVIDED <br /> D// � ' 3 SJ�` ,K!VES ONO ❑YES ❑NO <br /> BEDDING. VENT CIA IF El MALI HIGH WATER NUMBER GF ROAD' PROPERTY BUIJyJLlING. VENT TO FRESH <br /> ALARM JI Ll� ( ( ' AIR INLET <br /> FEET FROM / {Y' <br /> OYES - O DYES 1:1 NO NEAREST <br /> DOSING CHAMBER: <br /> MANUFACTURER BEDDING 1IOUII1 I APA(:'IV YII VMIIIIEL PUMP SIPRON IJANUI Al 11111111 WARNING LABEL LOCKING COVER <br /> PROVIDED PROVIDED'. <br /> ❑YES ❑NO DYES ❑NO EYES ❑NO <br /> GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF 11HOP11ITY WELL BUILD N(I VENT TO FRESH <br /> (DIFFERENCE BETWEEN IF ET FROM ( LINE AIR INLET <br /> PUMP ON AND OFF) ❑Y S ❑NO IN <br /> SOIL ABSORPTION SYSTEM.Check the soil moisture at the de th OfplDwing IINrn11 1114MI1111 MAH HmI AND MARKIN', <br /> or excavation. (If soil can be rolled into a wire,construction ffi II cease until FORCE <br /> the soil is dry enough to continue.) !. MAIN <br /> CONVENTIONAL SYSTEM: I <br /> BED/TIMCNOH• <br /> WIDTH LENGTH' NO Or 1 I11H PIPill” NT, u <br /> COVER INS1E D1n _Pl rs uou1D <br /> ) j 3, --/ I <br /> TIII IRI � MAT I PIT DEPTH <br /> DIMENSIONS <br /> LITAVIL J111 H FILL DEPTH DISIH PIP! OISTH PIPE DISTRPIPE MATERIAL NO Osrll NUM ER OF. PROPERfV WEyjyj'�'� BUILOIN�y VENT TO FRESH <br /> eE Lnw PI E�I ABovE cont/Flp E1//yy__v���1yy//LF1 EL/EV (Nu I �E-r / ^ PIPE�S1 FEET FROM .: LINE, / 460 ;A <br /> /� A1R�rJ <br /> U IGJ U+ /�21 �' V ` oC. NfARfST---s "'' �!�/1TeJ 9&t 17'' <br /> MOUND SYSTEM: I y 9 <br /> Mound site plowed perpendicular to slope Checks the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM <br /> and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- <br /> meetsthe criteria for medium sand. TIONS MEASURED. <br /> ❑VES QNO <br /> SOIL COVER TEXTURE Pl liMnw NI AtARKF HE DBSEH VA n'IN wuLs <br /> _ ❑VES ONO _DYES [:]NO <br /> DEPTH OVFR TRENCH RED DEPTH OV1R u1ENCH Blu ulvnl ull Tnvsn,L lnuDlu SFturu MVLCRED <br /> CENTER EDGES <br /> ❑YES. ONO DYES ❑NO DYES ❑NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> BEDI/eTRENCH WIDTH LErvcn1 NRENCHEs L rE HAL SPAclrvrr rrHnvEL(IF".HE Luw"'I F ILL DPPTD ABOVE COVER <br /> OIMEN$fON$ : 1 <br /> MANIFOLD PUMP MANH OLU DI TR PIPE MANIIOLO MATERIAL ND DISIH DISTR PIPE DISTHIBU I IDN PIPE MATERIAL&MAHKIN(i <br /> fIfVATION AN[1 <br /> ELEV. ELEV CIA ELEV PIPES DIA <br /> DISTRIBUTION' <br /> INFORMATION HOLE SIZE HOLE SPACING OHILL L O COHHF C II V COVER MATERIAL LADS(At LIF T CORRESPONDS TO APPROVED <br /> v1'� DYES ENO ❑YES [:]NO <br /> COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS NUMBER Oh•. PROPERTY WELL. BUILDING <br /> FEET FROM <br /> LINE <br /> OYES ❑NO ❑YES ❑NO NEAREST= <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> 5 TITLE _DILHR SBD 6710 (R.01/82) � `�✓�7 // �7 <br />