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 <br /> CONVENTIONAL ❑ALTERNATIVE IState Plan I.D.Number: <br /> ❑Holding Tank ❑ In-Ground Pressure Mound [if assigned) <br /> NAME OF PERMIT HOLDER: JADDRESS// OF PERMIT HOLDER: INSPECTION DATE: �9 <br /> ��ife yvtOw/uwe 73� SAN'ta �� COur� znr.�tow s —'PD — 4� <br /> BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. <br /> Name Plumber: MP/MPRSW No.: County Sanitary Permit Number: <br /> oc� o k�wS O30 S9 �c,�rn�e / 0893 �10(0�3 <br /> SEPTIC TANK/HOLDING TANK: <br /> MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER <br /> PROVIDED: PROVIDED: <br /> `75 ,:t., Gf$ 98, q YES ONO ❑S —]NO <br /> BEDDING: VENT DIA.: VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPERTY WELDI� BUILDING: VENT TO FRESH <br /> ALARM. LINE: pJO AIR INLET: <br /> /� ---�- FEET FROM <br /> ❑YESNNO `7 ��� ❑YES LJNO NEAREST ��0® �O <br /> DOSING CHAMBER: <br /> M FACTURER-. BEDDING: LIQUID CAPACITY PUMP MODEL. JPUMP/SIPHON MANUFACTURER IWOYES <br /> ARNING LABEL LOCKING COVER <br /> PROVIDED: PROVIDED: <br /> ❑YES ONO ONO OYES ONO <br /> IGALLON CLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENTTOFRESH <br /> (DIFF ENCE BETWEEN FEET FROM LINE AIR INLET: <br /> P ON AND OFF) OYES ❑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 /> the soil is dry enough to continue.) MAIN <br /> CONVENTIONAL SYSTEM: <br /> WIDTH: t LENGTH. , NO.OF DISTR.PIPE SPACING: COVER DIA. ttPITS. LIQUID <br /> BED/TRENCH ] / TRENCHES / MATERIAL: :[:�71NSIDE <br /> DEPTH: <br /> DIMENSIONS / ! (�// r�W <br /> GRAVEL DEPTH FILL DEPTH JDISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH <br /> BELOW PIPES ABOVE COVER ELEV,I ELEV.END. t1 S- LINE Q / I AIR INLET: <br /> .i O/ /3• #��PVL NEARESTFEET OM ��Q� ' [/ I,,-- <br /> P'P�D <br /> MOUND SYSTEM: <br /> ound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM <br /> a furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- <br /> ❑YES NO <br /> meets the criteria for medium sand. TIONS MEASURED. <br /> ❑ <br /> SOIL COV R ITE.TURE: PERMANENT MARKERS OBSERVATION WELLS <br /> J <br /> DYES FIND ❑YES ONO <br /> DEPTH OVER TRENCH BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED. MULCHED: <br /> CENTER EDGES <br /> EYES ONO I ❑YES ❑NO OYES El NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> WIDTH. LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: <br /> BED/TRENCH TRENCHES: <br /> DIMENSIONS <br /> MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: JNO;� STR.PIPE DISTRIBUTION PIPE MATERIAL&MARKINGELEV.: ELEV.. DIA.: ELEV: PIP <br /> ELEVATION AND <br /> DISTRIBUI ION <br /> INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED <br /> PLANS: <br /> OYES ❑NO _ OYES ONO <br /> COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. <br /> FEET FROM LINE: <br /> ❑YES ❑NO OYES ENO NEAREST <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> SIGN E: 1:;�Ivl!�4 <br /> DILHR SBD 6710 (R.01/82) <br />