Laserfiche WebLink
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS <br /> LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION <br /> P.O. q0X 7969 ' BUREAU OF PLUMBING <br /> MADISON,WI 53707 �, <br /> L`t`-1CONVENTIONAL ❑ALTERNATIVE s„te vl�nlo.N�me.. <br /> ❑ <br /> � 111 a„,nMi Hol ing Tank ❑ In-Ground Pressure ❑ Mound <br /> NAMF,OF PERMIT HOLDE AODRESSOF PERMIT HOLDER -� INSPECTI N DATE <br /> �lC(la�d arrtn ab70 , I Afcll �(TXvII�P, <br /> BENCH MARK WE—...t et—Icep—ITEESCRIBE IF DIFFERENT FROM PLAN REF.PT. LEV.: LST REF.PT.ELEV. <br /> Name of Plu M1e�. MP/MPRSW NII Cnu..t San�tary P rmil Number <br /> Rod �� ,; �o '0rne -� , 7o� <br /> SEPTIC TANK/H6EDTRl <br /> MANUFACTURER LIQUID CAPACI TV TANK INLET ELEV TANK OUTLET ELEV WARNIN LABEL LOCKING COVER <br /> q q �J PROVIDE PROVIDED <br /> `/ /t / VES END EYES ENO <br /> BEDDING: VERT OI0.. VENT"II HIt111 WATER NUMBER OF ROAD PHOPEHTV W LL BUILDING VENT TO FREER <br /> I/ ALARM FEET FROM LINE / / AIR INLET <br /> DYES NO C 'Q� YES ❑NO NEAREST HO �� '-� <br /> DOSING CHAMBER: <br /> MANUFACTURER BEDDING LIOVIn CAVACIrr 1'uMqP MI <br /> IIA PUMP 511'HpN MA�VI AEIIIRHI WARM GLABEL LOCKING COVER <br /> 7 / PROVID O PROVIDED <br /> rl ^—�'ti V S ❑NO I XYES ENO <br /> ❑YES ®NO <br /> GALLONS PER <br /> CYCLE: PUMP AND OONT ,O OPERATIONAL NUMBER OF PH'1PIHry w.0 eICamN<� VErvT rD FRESH <br /> (DIFFERENCE BETWEEN —7 {5 AIR IN/LET <br /> PUMP ON AND OFF) / YES ❑NO NEAREST—+� '✓D� / <br /> SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I 1 NpIII )AMI nH MATIIAL ANO MARKING <br /> or excavation. (If soil can be rolled into a wire,construction shall cease an FORCE.. , 1. <br /> the soil is dry enough to continue.) :MAIN <br /> CONVENTIONAL SYSTEM: <br /> WIDTH LENGTH NO of nIs1H PIP1 AI ICV wSlnt 111, =Pl rs uQUm <br /> BED/TRENCH Pt rHl'I S IIAI I II AI: PIT 05vrH <br /> DIMENSIONS'.. <br /> GRAY LD H FILL DEPTH I1151H P11`f DISTH PIPE D15TR.PIPE MATERIAL NO UI[IH NUMBER OF J PROPERTv WELL BVILDINC VENT TO FRESH <br /> BE LOW PIPES ABOVE COVER EIFV INIII ELEV LNU PIPfS IFE•EnT FROM LINE AIR INLET <br /> NEAREST--r <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 ME SURED. <br /> 1:1 YES ❑NO <br /> SOIL COVER TEXTURE PI UN ANINI MAUKIHs msurvAnnN wF US <br /> DYES ❑NO _❑YES ❑NO <br /> DEPTH OVER TRENCH BED OE PrH OVFH THFNC11H 11U119H Uf 1OP51nL 5111 11 SFf UrD MULCHED <br /> CENIEH EDGES <br /> ❑VES. ❑NO ❑VES NO ❑VES ENO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> WIDTH LEND rII NO.OF LAT E H AL SPACIN[i (+RAVEL DEPTH Hf LlIW PIYI FILL EPTII ABOVE COVER <br /> BED/TRENCH TRENCHES <br /> DIMENSIONS-.- <br /> MANIFQLD PUMP MANIrOL1) DISTR.PIPE MANIFOLD MATERIAL N(1 DISTH DISTR PIPE DISTH FICTION PIPE MATERIAL&MARKINIi <br /> ELEV. ELEV DIA ELEV PIPES DIA <br /> ELEVATION AND <br /> DISTRIBUTION 0LEvzE TOLE SPACINC. DIuuLU CnHHrCILY COVERMATLHIAL VERT CAL LIFT CORRESPONOSTOAPPROVFD <br /> INFORMATION; PLAN <br /> ❑YES ❑NO DYES LINO <br /> COMMENTS] PERMANENT MARKERS: OBSERVATION WELLS NUMBER OF "LINE ERTY WELL: BUILDING. <br /> FEET FROM <br /> ❑VES ❑NO ❑VES ❑NO NEAREST—; <br /> C L C � <br /> Sketch System on Retain in county file for audi . <br /> Reverse Side. <br /> slfi r RE TITLE / <br /> DILHR SBD 6710 (R.01/82) <br />