Laserfiche WebLink
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 C/ (W,A ( 4 C07a ALTERNATIVE <br /> CONN N NAL ❑ALTERNATIVE szre Plan lD Num6er. <br /> ❑Holding Tank ❑ In-Ground Pressure ❑Mound ur alry��l <br /> NAME OF PERMIT HOLDER. A SS OF PERMIT HOLDER'. -,INSPECTION DATE <br /> BE M MARK IPermanem rererenc loll DESCfl IBE IF Op"EH T FROM PLAN. REF.PT.ELEV.: CST FEE PT.ELEV <br /> NP-1 PlumOer. , MP/MPq$W No. CF., s-1,Permit Number. <br /> ?k oao�9 <br /> SEPTIC TANK/HOLDING-TANK: <br /> _HNUFAC TUBER. FLIOUIDPACITY. rANKINLETELEV. TANK OUTLET ELE VWARNING LABEL LOCKING COVER <br /> ROVIDED'. PROVIDEDYES ❑NO ❑YES ❑vENTDIq. vENr MgTL.. HICHNUMBER OF ROAD'. PROPFRTv WELLARFEET FROM T❑VES ❑NO ❑ NO NEAREST <br /> DOSING CHAMBER: <br /> MANUFACTURER BEDDING LI(]UID CPPACIiv PUMP MODEL PUMP 5IPHONMq N—.1 UFIP WARNING LABEL LOCKING COVER <br /> PROVIDED PROVIDED' <br /> DYES ❑NO DYES ENO DYES ENO <br /> GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENTTOFRESH <br /> (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. <br /> PUMP ON AND OFF) ❑YES ❑NO NEAREST• <br /> SOIL ABSORPTION SYSTEM.Check thesoil moistureat thedepth of plowing LENcnI. DIAMETER MgTFHIAI AND MgHKmc <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 /> CON V E/�{pN�TIIOy/N�A�L SYSTEM: <br /> BEDa�a WIDTH LFNGrH NOE OF <br /> DISTE PIPE SPACING COVER INSIDE DIA #PITS LIDUID <br /> DIMENSIONS l..' r j j ' / fN <br /> PIT DEPTH. <br /> GRAVEL DEPTH FILL DEPTH UISTH PPF DISTR PIPE O15Tq.PIPE MATERIAL SLI PROPERTY- WELL 9UILOING. VENT TO FRESH <br /> BELOW PIPS ABOVE COVER ELEV INLET ELEV,E OH UM ER OF LINE ! T� <br /> (� FEET FROM -'7 / t• /� AIR <br /> �E <br /> 4 NEAREST <br /> MOUND SYSTEM: <br /> Mound site plowed perpendicular to slope Checkthe 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 /> ❑VES ❑NO meets the criteria for medium sand. TIONS MEASURED. <br /> SOILCOVER ITEXTURE <br /> PERMANENT MgHKEHS OBSERVATION WFLIS <br /> ❑VES ❑ND DYES_ NO <br /> DEPLH OVER TRENCH.BEO DEPTH OVER TRENCH;BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED <br /> CENTER EDGES <br /> ❑YES ❑NO ❑VES ❑NO ❑VES ❑NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> BED/TRENCH WIDTH LENGrH TFEONCHEs. LATERAL SPACING. GRAVEL DEPTH BE Low PIPE FILL DEPTH ABovE co H <br /> DIMENSIONS <br /> MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO DISTR DISTR PIPE DISTRIBUTION PIPE MATERIAL&MARKING <br /> ELEVATION AND ELEv. ELFv. CIA ELEV. PIPES DIA.: <br /> DISTRIBUTION <br /> INFORMATION HOLE SIZE HOLESPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO'APPROVED <br /> PLANS <br /> ❑VES ❑NO ❑VES ❑NO <br /> COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS. NUMBER OF PROPERTY WELL BUILDING. <br /> FEET FROM LINE <br /> ❑VES ❑NO EYES ❑NO NEAREST <br /> �r �La.r�c �r� GL'��L�c���ya-r✓7..de�� ���L <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> SIGN RTnLF. <br /> DI LHR SBD 6710 R.01/82) 1 <br />