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0Dne Al rec" <br /> DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS <br /> LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION <br /> BUREAU OF PLUMBING <br /> P.O.BOX 7969 <br /> MADQON,WI 53707 <br /> CONVENTIONAL L-1 ALTERNATIVE slate vLnllo.Number <br /> m aaa�enaa <br /> ❑Holding Tank ❑In-Ground Pressure ❑Mound <br /> ME OF FERMI LOER. ADDRESS OF PERMIT HOLDER'. INSPECTION DA E/ / <br /> eENLH MA IPermanem reference pomH DESCRIBE IF OIFFERENT �oA� �� <br /> FEE PT.ELE Vd CST REF.PT.ELE V. <br /> S��► F' /ao <br /> N m pI PI umber MPIMPRSW No.'. County Saneary Permu Numbe <br /> e15 r 5 J cr 1303 <br /> SEPTIC TANK/HOLDING TANK: <br /> MANUFACTUNEP. LIQUID CAPACITY. TANK INLET ELE V.. TANK OUT ELEV.. WARNING LABEL LOCKING COV ER <br /> a p �j�/ / P OV EP PROVIDED'. <br /> I P� V0� G�[ p � / /ip� VES ❑NO VES - <br /> REDOING YFIYZ.OIA. V MAT L. HIGH WATER NUMBER OF C34 ' <br /> GAD'. PROPERTY WELC BUILDING. VENT TO FRESH <br /> II /�y� ALARM /) LINE f r AIR INLET <br /> DYES ❑NO 9 ` 1`Y ❑VES L1 N- NEARESTFEET M C3D 1,•tY�( O was ' --- <br /> DOSING CHAMBER: <br /> M NV FACTURER REDDING. LIOVID CAPACITY PVMPMOOEL PUMP/SIP TONMANUFACTIIRER WARNING LABELtMARKING <br /> NGLOVER <br /> 1. I r 5 POVfDDED <br /> ED <br /> if <br /> ftiI ❑VES NO Y ES ❑ YES ❑NO <br /> PUMP ANO CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL G VEN'NLOT RE511 <br /> GALLONS CE CYCLE: y(a(DIFFERENCE BETWEEN FEET FROML?E� Df 3d / �l�PUMP ON AND OFF) ❑VES NO NEAREST—I oCSOIL ABSORPTION SYSTEM.Check thesoil moistureat thedepth of plowing LFNrrH DIAMFTEe MArFRwL ANDFORCE �d� '1or excavation. (lf soil can be rolled into a wire,construction shall cease until MAIN U U <br /> the soil is dry enough to continue.) <br /> CONVENTIONAL,YSTEM: - <br /> WIO N LENGTH NO.OF DISTP.PIPE.4P AC IN" COVER I INSIVE DIA aPI15 ..LIQUID <br /> BED/TRENCH -^ rRENCHEs // [ wAr/ IY Y IT - DEPTH <br /> DIMENSIONS 3 �)cq r CD <br /> GRAVEL DEPTH / FILL DEPTH DIErN PIPE DISTR PIPE DIST. PIPE MA77TAL O DbTH NUMBER OF FROPERTV WELL I BUILDING. VENT TO FRESH <br /> BELOWPIPE/S / ABOVELOVfy FIFv mLFI ELEV END vx0 j.,e' Pme FEET FROM 'L�� / 'C� � AIR INLET <br /> S1` q/SI,It l NEAREST--►'-.' <br /> MOUND SYSTEM: <br /> Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM <br /> and furrows thrown upslope: mound systems to make certain that it ON REVE RSE SIDE.SHOW ELEVA- <br /> meets the criteria for medium sand. TIONS MEASURED. <br /> ❑YES El NO <br /> PENMAN!NI Ml1NKE H5 DBSEN VAIIDN WI IIS <br /> SOIL COVER TexrURF. <br /> _ ❑YES ONO 1:1 YES ❑NO <br /> DEPTH OVER TRENCH:BFD OEPTIIOVER THENCH.BED DEPTH OF TOPSOIL SODDED SEEUFD MULCHED r <br /> CENTER EOGEC NO <br /> ❑VES ONO 11 YES C�NO ❑VES NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> WIDTH LENGTH ND.of LATERAL svnclrvG GRAVEL DsvTN BF Lnw PIPI FILL DEPTH ABOVE covEH <br /> BED/TRENCH TRENCHES <br /> DIMENSIONS <br /> MANIFOLD PUMP MANIFOLD pISTR PIPE MANIFnLDMAiEH1AL POESISTH U1SATR PIPE DISTIIIRV IIDN PIPE MATL{IIAIPMAHKINL <br /> ELEV ELE V. DIA ELE V. <br /> ELEVATION AND <br /> DISTRIBUTION HOLE s¢E HOLE SPACING DRILLED CDHRELTLY covER MArENIAL vEHncnL urr coPREswTrvos TO APPROVED <br /> INFORMATION PLANS <br /> ❑VES El NO [:1 YES ❑NO <br /> COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL'. BUILDING. <br /> FEET FROM LINE <br /> On <br /> . <br /> Otl� c�F ly LINO NO ❑VES ❑NO NEAREST <br /> 1� <br /> 1 7A �L (� 9 <br /> 13 Z &'C/ II q41, 3i s, <br /> el"I5*P <br /> 5'y= <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. TITLE <br /> ILHR SBD 6710(R.01/82) <br />