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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 /> ONVENTIONAL El ALTERNATIVE 5111¢Plan I.D.Npmee,. <br /> I I a..�Pnevl <br /> Holding Tank ❑ In-Ground Pressure 11 Mound <br /> NAM OF PERMITHOLDER. gDDRE550F PERMIT HOLDER: j/� INSP�O %TE <br /> 9 sJpaj <br /> BENCH MARK IPeimanecl.elerence ppmH DESCRIBE IF DIFFERENT FROMPLAN. 10 REE.PT.ELEV. CST REF.IT ELEV <br /> z0ow �' o k Sw e0r�'�'- 1/) U <br /> Nem of Plum MPIMPRSW N. Cpu Samlary Permit Number. <br /> 03,9,'r'? mel*�tsa2Y la /Q 117J <br /> SEPTIC TANK/HOLDING TANK: <br /> MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV TANK OUTLET ELEV WARNING LABEL LOCKING COVER <br /> cJ PRO IDED PROVIDED <br /> Invv ,oI, g IQ' tl ( YES ❑NO ❑YES ❑NO <br /> BEDDING. VENT DIA.. VENTMITL.. HIGHWATER NUMBER OF ROAD: PROPERTY WELL // BUILDING. VENTTOFRESH <br /> ALARM LINE I ILfQ (^DI AIR INLET. <br /> ❑VES ONO DYES ENO NEAREST >/d 0 ( 7:7'j 0 )5JJ U/ <br /> DOSING CHAMBER: <br /> MANUFACTURER BEDDING LIOOID CAPACITv PUMPMODEL 11N IPHON MANUFACTURER WARNING LABEL LOCKING COVER <br /> PROVIDED. PROVIDED. <br /> ❑VES ONO ❑YES LINO ❑YES ❑NO <br /> GALLONS PER CYCLE: PUMP ANo CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENTTOFRESH <br /> (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. <br /> PUMP ON AND OFF) DYES 11 NO NEAREST <br /> SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING <br /> or excavation. (If soil can be rolled into a wire,construction shall Cease until FORCE <br /> MAIN <br /> the soil is dry enough to continue.) <br /> CONVENTIONAL SYSTEM: <br /> BED/TRENCH WIDTH / LEENNGTH NOERCHES DISTR PIPE SPACING COVER L PIT IN51DE DIA #PITS DEPTH <br /> DIMENSIONS 1 Sia Ir• <br /> GRAVEL DEPTH FILL DEPTH UISTR PIPF DISTR PIPE DISTR.PIPE M TERIAL NO DISTR NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH <br /> BELOWPIPEs51 A6O'FTCOVER EIEV INLET IF T11 END IJ ,. b PIPES FEET FROM LINE/ ^,d `G AIR INLET. <br /> * ` ��1 I00.7 001 Ie l L/ V` NEAREST—� (�° 'art/ .9 � f <br /> MOUND SYSTEM: P 7-2 <br /> Mound site plowed perpendicular to slope Check 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 /> meets the criteria for medium sand. TIONS MEASURED. <br /> ❑YES NO <br /> SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS <br /> LIVES LINO ❑YES ❑NO <br /> DEPTH OVER IRENCH R E O DEPTH OVER TRENCH:BED DEVTH OF rOPsoIL SODDED SEEDED MULCHED <br /> CENTER EDGES <br /> DYES EJ NO 1 1-1 YES El NO ❑YES El NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> WIDTH LENGTH NO.OF LATERALSPACINCr. GRAVEL DEPTH BELOWPIPF FILL DEPTH ABOVE COVER <br /> BEDITRENCH TRENCHES. <br /> DIMENSIONS <br /> MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL <br /> ELEVATION AN <br /> ELEV. ELEV DIA. ELEV. PIPES DIA. <br /> DISTRIBUTION <br /> INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS CAL LIFT CORRESPONDS TO APPROVED <br /> ❑YES ❑NO ❑YES ❑NO <br /> COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMB@RDF• LRIOEERTY WELL. BUILDING'. <br /> DYES ❑NO EYES Cl NO NEAREST <br /> M 3 S 6 , o (C 57- 1301wA if'"'Orli ) <br /> �k'A r, III Id c� I ��F +o <br /> 13 T 3 IOu17 Ceres sJ {tae />n/Lc zl� �EI�J <br /> U A/T ��1P1.1'( d 3'.3(0 !Du•bH <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> SIGNAT TITLE <br /> DI LHR SBD 6710 (R.01 182) 1= �' <br />