Laserfiche WebLink
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING <br /> LABOR&HUMAN RELATIONS DIVISION <br /> P.a-i36X 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION <br /> MADISON.WI 53707 State Plan I .Number. <br /> CONVENTIONAL ❑ ALTERATIVE (il assigned) <br /> ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound <br /> NAME OF FEF V!T HOLDER ADDRESS OF PERMIT HOLDER: INSPECTION DATE. <br /> Pry �� 0 7-I `f01 <br /> - <br /> BE H MARK(Per t r A,encs Pomq DE CRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.'. OST REE PT.ELEV.. <br /> a 2 <br /> Name umber. MP/MPRSw No.: County: Sanitar Permit id <br /> erm�� �.�rson <br /> SEPTIC TANK/HOLDING TANK: <br /> MANUFACTU ER: LIQUID CAPACITY: TANK INLET ELEVr. TANKOUTLETELEV.'. WARNINGLABEL LOCKING COVER <br /> Al- f_ sd� J / PR IDED P <br /> e er-' l`L, iLF��F/A1– 1J00 YES ❑NO 71YES ❑NO <br /> BEDDING: VENT DIAL VENT MATL HIGH WATER NUMBER Olir ROAD. / PROPERTY WELL BUILDING:I VENT TO FRESH <br /> 11 ALARM- FEET FROM uNe ^� LAIR INLET: <br /> ❑YES NO [e,S—�' ❑YES ❑NO NEAREST �'^' 3 �o. "-'—' <br /> � /DOSING HAMBER: <br /> �F MANUFACTURER BEDDING LIOUIDCAPA ITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER <br /> PROVIDED: PROVIDED: <br /> 124 QN ❑YES NO YES LINO YES ❑NO <br /> GALLONS PER CYCLE / PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERT WELL'. BUIL01 : ENT ro FRESH <br /> (DIFFERENCE BETWEEN FEET FROM LINE / � AI NL J <br /> PUMP ON AND OFF) .Jw YES Ll NEAREST--- 71b D �J <br /> SOIL ABSORPTION SYSTEM. Check the sail moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKIING. <br /> or excavation. (If Soil Can be rolled into a wire,construction Shall cease until MAIN (FD` <br /> the soil is dry enough to continue.) <br /> ONVENTIO_NAL SYSTEM: <br /> WIDTH LENGTH NO.OF DISTR.PIPE SPACING. COVER INSIDE CIA.: $PITS: LIQUID <br /> ?BELOW <br /> RENCH I � / TRENCHES. MAT RIAL PIT �— �� DEPTH <br /> ENSIGNS G <br /> EL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIA NO DIS - NUMBER OF PROPERTY WELL: BUILDING VENT TO FRESH <br /> PIIPNES: ABOVECOVER� ELEV.INLET: EL V.EN PIPES FEET FROM LINE ✓ AIR IN T. <br /> '111 ii//11// 3 NEAREST � b0 J f <br /> MOUND SYSTEM: <br /> Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM <br /> slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW <br /> ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. <br /> SOILCOVER TEXTURE-. PERMANENT MARKERS' OBSERVATION WELLS', <br /> ❑YES ❑NO ❑YES ❑NO <br /> 1_---._ <br /> DEPTH OVER TRENCH/BED I DEPTH OVER TRENGHIBED DEPTHS OF TOPSOIL ISODDED GEEDED MULCHED'. <br /> CENTER. EDGES. <br /> [I YES L-1NO ❑YES ❑NO ❑YES ❑NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> BED/TRENCH WIDTH: LENGTH. NO.OF LATERAL SPACING. GRAVEL.DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER' <br /> TRENCHES- <br /> ' DIMENSIONS <br /> MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO.DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING <br /> . <br /> ELEVATION AND ELEV.. ELEV.. DIA.: ELEV.. PIPES DIA. <br /> DISTRIBUTION HOLE SIZE: HOLE SPACING DRILLED CORRECTLY. COVER MATERIAL VERTICAL LIFT CORRESPONDS TO <br /> INFORMATION APPROVED PLANS <br /> ❑YES ❑NO ❑YES ❑NO <br /> PERMANENT MARKERS'. OBSERVATION WELLS. NUMBER OF PROPERTY WELL'. BUILDING'. <br /> COMMENTS: LINE <br /> FEET FROM <br /> � <br /> [-I YES ❑NO ❑YES [-]NO NEAREST <br /> / J� ( 6 <br /> I " <br /> In 16_ ^ 1 pp <br /> Sketch System on Flat 7 <br /> in county file for audit. <br /> Reverse Side. SIGNATURE'. /J TITLE <br /> SBD-6710(R.06/88) (Ui <br />