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DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS <br /> LABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION <br /> P.O.BOX 7969 <br /> MADISON,WI 53707 BUREAU OF PLUMBING <br /> ❑CONVENTIONAL ❑ALTERNATIVE ST."Plan 1.0.Number'. <br /> ❑Holding Tank ElIn-GroundPressure El Mound Ill abi in Xi <br /> NAME OF PERMIT HOLDERADDRESS OF PERMIT HOLDER: INSPECTION E'. <br /> az/oc we-Afe `35a W ebIS Fer HlaJ`Ue DeS Pl ,vicS C li <br /> BENCH MARK IPerman-,rlleren-PomlI DESCRIBE IF DIFFERENT FROM PLAN REF,PT.E EV.: CST REF.PT.ELE V. <br /> Alp, IIF- OfJ - /00— <br /> TV—.1 Plumber MP/MPRSW Nn. Cnunry. San,ury Pe n Numbm: <br /> Richarc( lu derSary (p9 90 50, e " <br /> SEPTIC TANK/HOLDING TANK: <br /> MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANKOUTLETELEV WARNINGLABEL LOCKINGCOVER <br /> ^ P'�,0._v/DED' PRIOVI�DED_ �-, <br /> o L]Q YES ONO L—1 Yes—'tJNO <br /> BEDDING'. VGKT DIA.. VIIpi MATT HIGH WATER UMBER UEF PROPERTY WELL: VENTTOFRESH <br /> BUILDING. <br /> I ALARM <br /> 7YES Sf' ❑VEs O w unEsr°M ` __ ORNe LINE AIR�INL <br /> DOSING CHAMBER: <br /> MANUFACTURER BEDDING. LIOVIIICArACITv VAMP MDIIEL PUMP:SIPHON MITNUI ACTUHkH WARNING LABEL LOCKING COVER <br /> ❑YES ONO <br /> PROVIDED'. PROVIDEDGALLONS PER L;YL;Ll:: '. <br /> OYES ONO OYES ONO <br /> (DIFFERENCEBETWEEN PUMP qNO CONTROLS OPERATIONAL RUM]BER:QF, ICHOERTY WELL BUILDING aERNNLO FRESH <br /> LINLET <br /> PUMP ON AND OFF) 'F£EF FRDN4, t;- <br /> ❑YES ONO <br /> SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth Diplowmg :IINI,IH uIAMFTER NIATTHIAI ANOMAXKINr, <br /> or excavation. (If soil can be rolled into a wire,construction shall cease until Fi?RCE„ <br /> the soil is dry enough to continue.) =_;iiYtAEN ;?,< <br /> CONVENTIONAL SYSTEM: <br /> WIDTH LENGTH NO OF UISIH PIPE SETO IN(. COVEH <br /> / INSIn1 Uln aPrtsai <br /> .. / THFNLHFs �c <br /> / / Mn Ef11Al PIT44 1 a <br /> L H FILL DEPTH U15111 PIPf UISiX PIPE DIST. PIPE MATERIAL N 1 G!H t T "PROPERTY WELL BUILDING <br /> BELOW PIPE$ // I gBOVE;OVE V EIFV INlll ELEV CNU VV pl f8E`t'f~Iki% '4P ( IT/- <br /> MOUND SYSTEM: <br /> Mound site plowed perpendicular to slope Check the 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 /> ❑YES ONO meets the criteria for medium sand. TIONS MEASURED. <br /> SOIL COVER TEXTURE i'I, AIINI MA1«LII$ ObsEHVATIIINwFus <br /> DE TRENCH BED VFN TRENCH REU UCPMOF TUp501L SHOW 11 DYES ONO DYES ONO <br /> C SEELIfO <br /> ENEDGES TER EDGES MULCHED <br /> ❑YES. ❑NO ❑VES ❑NO DYES ONO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> "WIDTH LENGTH NO.OF LAT E PAL SpACIN(i I:HAVEL OE ITT"➢I HELW PIPf FILL DEPTH ABOVE COVER <br /> [ � Rs .I. <br /> TRENCHES <br /> ELE VFOLD PUMP ELEV. MnNI[OLO OISTR.PIPE MANIFOLD MATERIAL NO IIISTH UISTR PI F 04iHIBU LION PIPE MATEXI4L8MARKING <br /> y�LG]a sy DIA ELEV. PIPES DIA <br /> YT (D4i.xL#Vf; <br /> EPoFQ}IyR�{S7C?R°tyy,HOLE 512E HOLE SPACING L`HILLEO COHHEQLV COVER MALEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED <br /> PLANS <br /> ' I; * "�q' DYES OND DYES ONO <br /> PERMANENT MARKERS. iVUMBER�F £y PROPERTY WELL: BUILDING'. <br /> COMMENTS oBBE.vgnON wens e.rel <br /> -.Lx .I LINE'. <br /> ❑VES ONO OYES ❑NO <br /> n / <br /> �tt5 TftNK T V. 13 T 9A e�z✓ To s a/ o�� <br /> b�' wheN cL.sEpl� cst Onn . <br /> q51 ©7P 9P C) n"9L S Jfe� Q ie 9s, L.A..lJ <br /> o k be.awe <br /> Sketch System on Retain in County file for audit. <br /> Reverse Side. <br /> SIGN E. / TITLE /7 <br /> DILHR SBD 6710 (R.01/62) { `'� <br />