Laserfiche WebLink
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING <br /> LABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISIOI <br /> P.O.BOX 7969 <br /> MADISON,WI 53707 BUREAU OF PLUMBINI <br /> CONVENTIONAL EIALTERNATIVE IState Plan l.o.Number <br /> : <br /> ❑Holding Tank ❑In-Ground Pressure ❑Mound r an.gnMI <br /> NAMEOF PERMIT HO LDER: UUH"S OF PERMIT HOLDERINSPECTION DATE: <br /> s>as q <br /> GSy� io <br /> BENCH MARK IPermanem Tele.....pomtl DESCRIBE IF DIFFERENT FROM PLN <br /> A <br /> REF.PT.ELEV.: CST REF.PT.ELE V.' <br /> Name of plumber No.. Caume: Sanlury PBrmH Number <br /> MP/MPgSW . <br /> 03as9 tL zL Gai3-7 Cl/F 7y <br /> SEPTIC TANK/HGLD7t1�TxRidK: <br /> MANUFACTURER: I LIOUIO CAPACITY: TANK INLETELEV.. TANK OUTLET I V.: WARNING LABEL LOCKINGCOVER <br /> Pf�pVIDEO: PROVIDED'. <br /> (/j/ •I/ 4i��1+ /(/G/!f/l/ Lf' 3 / YES ❑NO ❑VES ❑NO <br /> BEDDING: VENTDIA.: VENTMgTI.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BU,(LOING. VENTTOFRESI <br /> ,� .r ALARM FEET FROM ', ! LINE -I/,� <br /> `` // AIR INLET. <br /> ❑VES NO ,47 <br /> J DYES ❑NO NEAREST hL) jfJe A-ic5~ <br /> DOSING CHAMBER: <br /> MANUFACTURER. BEDDING: _ LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKINGCOVER <br /> PROVIDED: PROVIDED: <br /> DYES ONO <br /> OYES ONO OYES ONO <br /> GALLONS PER CYCLE: PUMPArvD CONTROLS OPEggnorvAL: UMBER OF PROPER <br /> wELL BUILDING V NT TO FRED <br /> (DIFFERENCE BETWEEN F B7,6R M yLINE. ARMLET <br /> PUMP ON AND OFF) ❑VES ❑NO IYAtIEST <br /> SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENcrH DIAMETER MATERIAL AND MARKING <br /> or excavation. (If sail can be rolled into a wire,construction shall cease until FORCE, <br /> the soil is dry enough to continue.) �011101A 7.x:5 <br /> CONVENTIONAL SYSTEM: ;......" <br /> p .'^ S WIDTN ) LE T / NO_OF 016TR.PIPE 6PACING. OOV ER _ INSIDE DIA. *PITS. LIQUID <br /> 4W / / TRENCHES. MATE AL' 1 '> Te iV, DEPTH'. <br /> RAVEL DEPTN FILL OE ATN UISTq.PIPE p6TR PIPE pISTR.PIPE MATERIAL NO DISTR PgopE TY 6'. VENT i0 FRE51 <br /> BELOWPIPE r/ BOVE COVER ELEV INLET ELEV ENO. PIPES ;# '1 k, LINE' L/ AIR INLET. <br /> P 7 •t, ') / ^ ET" ROikY." z i ] <br /> ,P `.� J�� -IVEAkEST S- <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 /> meets the criteria for medium sand. TIONS MEASURED. <br /> ❑VES ❑NO <br /> OIL COVER TEXTURE <br /> PERMANENT MARKERS. OBSERVATION WELLS. <br /> ❑VES EJ NO OYES ONO <br /> DEPTH OVER TRENCH28EO DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEPED. MYLCHED. <br /> CENTER EDGES <br /> YES ❑NO ❑VES ❑NO ❑VES ❑NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> WIDTH NO.OF LATERALSPACING. GRAV LDEPTHBELOWPIPF FILL DEPTH ABOVE COVER. <br /> -=�EblTRraCH ;k <br /> LENGTH. TRENCHES'. <br /> T_�. L,rzri <br /> y q^m MANYOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR,PIPE DISTRIBUTION PIPE MATERIAL Is MARKING. <br /> ELEV.'. ELEV.: DIA.. ELEV.. PIPES. DIA.: <br /> HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED <br /> PLANS <br /> ❑VES ONO OYES ONO <br /> COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: Faf{An�FR PROPERTY WELL: BUILpING: <br /> �E�^Y#i-01 'LINE: <br /> DYES <br /> FIND OYES ONO EAREST. <br /> Sketch System on <br /> Reverse Side. Retain in county file for audit. <br /> SIG TYRE: TITLE: � ,,�•• _ <br /> DILHR SBD 6710(R.01/82) OL'jiJyf�,� "PZ,_ <br />