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Wisconsin Department Of Industry, ON SITE SEWAGE SYSTEM Safety& Buildings Division <br /> Labor and Human Relations INSPECTON REPORT <br /> P.O. Box 7969 JMCOUntdison,Wl 53707 y' <br /> NVENTIONAL ❑AT-GRADE ❑IN-GROUND PRESSURE ❑MOUND ❑HOLDING TANK <br /> EXPERIMENTAL ❑NEW ❑REPLACEMENT ❑RECONNECTION ❑OTHER(SPECIFY) <br /> PejmiF Holder's Nam : Perrrut Holder's Address:C�(,�O Insp[e-c-ti�7n aott <br /> hlloh .,b bi O o J O <br /> Bench Mar scribe I DI erent rom Plan: i Parcel Tax .D.No.(Optional) Ref.Pt.E ev.: CST Ref.Pt.Elev.: <br /> Plumber's Na MP/MP W No.: State Plan ID No.(If Assigned): S i ary Permit Number: <br /> SEPTIC T NKIHOLDINGT NK: <br /> Manua urer: Liquid CaCIIa�city: Tank Inlet Elev-: Tank Outlet Elev.: Warning Label Lock:ng Cover <br /> X I/? er / -dl ✓ - 3 Pp Yes E] No ❑ Yes <br /> Prov d❑ No <br /> Bedding: nt fria.: Vent Mat'L: High Water Alarm: NUMBER OF Road: Property Line: Well: I Building Air Vent: <br /> FEET FROMii <br /> 3/ <br /> DOSING CHAMBER: <br /> Manufacturer: Bedding: Liquid Capacity: Pump Mo e : Pump/Siphon Manufacturer: High Water arm Warning Labe Locking over <br /> Provided: Provided: <br /> ❑ Yes ❑ No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No <br /> Ga ons Per Cyce: Pump and Controls Operational: NUMBER Property Line:I Well: Building: Air Vent: <br /> (difference beoff)en FEETFROM <br /> pump Yes No I NEAREST--► <br /> Vent Installed: Vent Diameter: Vent Material: FORCE Length: Diameter: Material and Marking: <br /> VENT ❑ Yes ❑ No I I MAIN <br /> SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled into a wire,construction shall cease until <br /> the soil is dry enough to continue.) <br /> DISTRIBUTION STSTEM: <br /> BEDRRENCH Width: Length: No.Trenches: Lateral Spacing: Cover aterial: InsidR Dia: No-Pits: Liqui�: <br /> DIMENSIONS //7 PIT <br /> Gravel Below Pipe ill Above ipe: Inleett EEllev.: En Elev* Pipe Materia No.Distr.Pipes: NUMBER OF top rt <br /> Line: Well: Building: Air Venty <br /> tQ /O rig 9�" 96� 3 NEARESFEETFT--* " / ' lY ® � a✓< <br /> Manifold Elev.: Manifold Dia.: Manifold Material: No.Distr.Pipes: Distr.Pipe Dia.: <br /> ELEVATION AND <br /> DISTRIBUTION <br /> INFORMATION Hole Size: Hole Spacing: Drilled Correctly: Permanent Markers Observation Wells: Pump Elev.: Vertical LitCorresponds To <br /> Approved Plans: <br /> ❑ Yes ❑ No ❑ Yes ❑ No 1 ❑ Yes ❑ No ❑ Yes ❑ No <br /> MOUND SYSTEM: <br /> Mound site plowed perpendicularto Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM <br /> slope and furrowsthrown unslope mound systems to make certain that it ON REVERSE SIDE. SHOW <br /> ❑ Yes ❑ No meetsthe criteria for medium sand. ELEVATIONS MEASURED. <br /> IL VER Texture: Permanent Markers: Observation Wells: <br /> ❑ Yes ❑ No L] Yes ❑ No <br /> Depth Over Trench Bed Center: Depth Over Trench Bed Edges: Depths OTopsoil: Sod e : See a Muc e <br /> ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> COMMENTS:(Sketch System On Reverse Side) <br /> Signature: Title. <br /> (Keep a copy in your file for audit) <br /> SBD 6710(R.09/90) <br />