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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 El ALTERNATIVE State Plan 1.0.NumBer <br /> aa.�gnea� <br /> Holding Tank ❑ In-Ground Pressure E]Mound (it <br /> NAME OF PERMIT HOLDER/ ADO ESS OF PERMIT EILDER'. INSPECTION DATE'. J <br /> BENCH MARK Permane,1.ete,ence palm)OE IBE IF DIFFERENT FRO / W S73d q s J�_gS <br /> REF.PT.ELEV.'. CST RE F.PT.ELEV <br /> Name of PlumbYr/ MP/MPRSW No. County Sanpary Peomu NumLer. <br /> 17"iso 03059 6 6 <br /> 0/_� pa <br /> SEPTIC TANK/ K: <br /> MANUFACTUflER LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV W7EIF <br /> ING COVER <br /> > PIDED'. <br /> W Ct7�/GL. vL �sb 2 Qn 2 ENO [—]YES ENO <br /> BEDDING'. VENT DIA.. VENT MAiL. HIGH I'L NUN OF ROAD'. PROPEflTV . VENT TO FgESH <br /> if ALARM FEET FROM i/ LINE' <br /> ❑YES ❑NO ( AIRINLET <br /> ❑VES ❑NO NEAREST G U BOO <br /> DOSING CHAMBER: �y <br /> MANUFACTURER BEDDING. LIQUID CAPACI TY PUMP MODEL PUMP/SIPHON MANUFACTURED WARNING LABEL LOCKING COVER <br /> PROVIDED PROVIDED. <br /> EYES ENO [-]YES ONO DYES ONO <br /> GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY *ELL BUILDING vErvT TO FgESH <br /> (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET <br /> PUMP ON AND OFF) ❑VES ❑NO NEAREST <br /> SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORCE LENGTH DIAMETER MATERIAL ANDMARKING <br /> or excavation. Of soil can be rolled into a wire,construction shall cease until <br /> the soil is dry enough to continue.) MAIN <br /> CONVENTIONAL SYSTEM: <br /> /TaA"gr wIOrH. LENGTH , NO OF DISTR.PIPE SPACING COVER INSUEOUA <PITs LIQUID <br /> BED/aw IONS1 / ��/ / TRENCHES t OVER <br /> AL�. PIT DEPTH. <br /> DIMEp1$IONS l <br /> GRAVEL DEPTH FILL DEPTH UISiH.PIPE pISTH.PIPE DISTR.PIPE MgTERIgC NO.DISTR. NV BF.' OF PROPERTY WELL BUILpING'. V NT TO FflESH <br /> BELOW PIPE ABOVECOVER ELEv.INLEr ELEV.Ervp -yh PIPES FEET FROM LINE ,� C�6 AIR INLET. <br /> °� •7,� t NEAREST 7 <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 upslopes mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- <br /> ❑VES ENO meets the criteria for medium sand. TIONS MEASURED. <br /> SOIL COVER TEXTURE PERMANENT MARKERS. OBSERVATION WELLS <br /> Ll YES 1:1 No EJ YES ENO <br /> DEPTH OVER TRENCH BED DEPTH OVEq TRENCH;BEO DEPTH OF TOPSOIL SODDED SEEDEp MULCHED. <br /> CENTER EDGES <br /> III YES L]NO ❑YES ENO EYES ❑NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> BED/TRENCH WIDTH LENGTH. NoENCHEs: LATERALSPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER <br /> DIMENSIONS <br /> MANIFOLD PUMP MANIFOLD pI TR.PIPE MANIFOLD MgTERIAC NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING <br /> ELEVATION AND ELEV.. ELEV. of A. ELEV. PIPES OIA.. <br /> DISTRIBUTIOIN <br /> INFORMATION HOLE 512E HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED <br /> PLANS <br /> EYES ❑NO ❑YES ❑NO <br /> COMMENTS: PERMANENT MARNERs'. <br /> 085 E RVAT ION WE L LS'. NUMBEROF, PROPERTY WELL: BUILDING: <br /> FEET FROM LINE. <br /> DYES ONO 1:1 YES ONO NEAREST <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> SIGI�AT RE TITLE <br /> DI LHR SBD 6710 (R.01/82) <br />