Laserfiche WebLink
y-a147 `/ c°D <br /> DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS <br /> LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION <br /> P.O. BOX 7969 BUREAU OF PLUMBING <br /> MADISON,WI 53707 <br /> CONVENTIONAL ❑ALTERNATIVE SI.T,PIan P,tPF)L D Number <br /> ❑Holding Tank ❑ InGroundPressure ❑Mound 111 ae <br /> NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. <br /> INSPECTION DAiE. <br /> 015 �3� Dan - he. rn i �e MN,11,17/ 1 DESCRIBE IF DIFFERENT FROM PLAN REF.BE ELEV. ESTELL Pr.ELEV <br /> Nome'Itt BE mFe, MP/MPRSW Nei. C�uniy San,Pary 1,1m 1 N 11tPP /J <br /> 0305 f k 5 <br /> SEPTIC TANK/HBFLDfPoB-3AA1C: _ <br /> MANUFACTURER LIQUID CAPACITY TANK INLET ELEV TANK GUILEt ELEV WARNING LABEL LOCKINGCOVER <br /> PROVIDED PROVIDED <br /> 1 l P 5 Z G 631Yes ❑No -]YES ONO <br /> BEDDING VENT DIA VENT rnnl, meal wnrEH NUMBER OF ROAD PROPERry wELL euILDlrvc VENT TO FRESH <br /> AI ARM FEET FROM / LINE j _ IAIR INLET <br /> ❑YES )NO � LtLy1 [ ]YES ❑NO NEAREST ,P4 f <br /> DOSING CHAMBER: <br /> MANl11 ACTURFH BEDDING LIOVII)CAPnC IIv FIIAIP MUUEI PUMI'SIPHUNMnNVIHI IIWHI WARNING LAPEL LOCKING COVER <br /> PROVIDED PROVIDED <br /> DYES ❑NO DYES LINO EYES ENO <br /> GALLONS PER CYCLE: PUMPAND CONTROLS OPERATIONAL NUMBEROF PHovEHry wEu Pu1LDINe VENT TO FRESH <br /> (DIFFERENCE BETWEEN FEET FROM.. LINF AIR INLET. <br /> PUMP ON AND OFF) F-1 YES ❑NO NEAREST—> <br /> SOIL ABSORPTION SYSTEM.Check the soil mmsture at thedepth of plowing 1EWITH u1AMETE11 h1An RIA, ANDMA"INr; <br /> or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE <br /> the soil Is dry enough to continue.) MAIN <br /> CONVENTIONAL SYSTEM: <br /> wmTH LENGTH NO nr DISTR PI 1 sPACINii cnVPH IN91uE DIn <br /> BED/TRENBFk �7 / nn NC Lrs % rf.R lnr PIT vl rs uoulD <br /> DIMENSIONS j f J- L7 / DEPTTI <br /> GRA VCL OFVTH I LLOEPIH ti1H III PIP UISTH PIPF U13TR.PIPE MATERIAL NO DISIH NUMBS OF. PROPERTY WELL BUILOINO EENT—T FRESH <br /> RFI ow PIPE' , ABOVE <br /> covo ELEV INIII ELEV iND 7� PMS FEET FROM LINE AwwLET� <br /> ��U. `''"G•3 <br /> I / � �z 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 REVERSE SIDE.SHOW ELEVA- <br /> ❑VES ONO meets the criteria for medium sand. TIONS MEASURED. <br /> SOIL COVER TiXTUHF 'I nVANI N I MARK na uRSERVA1lnN wE L IS <br /> DYES ENO _❑YES 0N <br /> ULP111 I'VEH THE NL II HE D DEPTH Ulf.TIIENC II HE IT I11PIIIII1 T1IP11RL S�R]HfD ]FL DI II MULCHED <br /> CENIIH EDGES <br /> IVES. ONO ❑VES ❑NO ❑VES ONO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> BED/TRENCH WIDTH LENrnr NTONCIIEP EArEHAL SPArwr, GHnvELDEPTHRE111w PIPI FILL DEPTH ABOVE COVER <br /> DIMENSIONS <br /> MANIFOLD PUMP MANH(1LID pISTA PIPE MANIEDLU MATFRIAL N(1 DISTH DISTR PIPE DISTHINDIION PIPE MATFRIAL&MARKING <br /> EEV. ELEV DIA ELEV PIP <br /> LS DIA. <br /> ELEVATION AND <br /> DISTRIBUTION <br /> INFORMATION HULL SIZE HOLESPACINo TIOLI EDCOHHEC IT YGov EH MATFRIAL VERTICAL LFT CORRESPONDS to APPROVE[)PLANS <br /> ❑YES ONO DYES ONO <br /> COMMENTS: PERMANENT MARKERS oas ERvnnoN wens— NUMBER OF PROPERTY weu euaDING <br /> .FEET FROM LINE <br /> DYES ONO 1:1 YES LINO NEAREST <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> s",1rµHE TITLE <br /> DILHR SBD 6710 (R.01/82) ���'�� �— <br />