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Wisconsin.Department Of Industry, ON SITE SEWAGE SYSTEM Safety&Buildings Division <br /> Labor and Human Relations INSPECTION REPORT <br /> P.O:BpT 7969 <br /> MMaa-dison,WI 53707 County: bur-I'}P� <br /> �cONVENTIONAL ❑AT-GRADE E3IN-GROUNDPRESSURE ❑MOUND ❑HOLDING TANK <br /> XPERIMENTAL ❑NEW ❑REPLACEMENT ❑RECONNECTION <br /> C-]OTHER(SPECIFY) <br /> Pera Ider s Name: Per 't Holder's Address: liTefrac� Inspection Date: <br /> x77- p <br /> ZOO 7 _ -ll <br /> Benc ark,Describe If Di eren m Plan: / ^ ^1, Parcel Tax I.D.No.(Optional) Re .Pt Elev.: CST Re .Pt.Elev.: <br /> P umbe 's Name: MP/MPRSW No.: State Plan ID No.(If Assigned): Sanitary Permit Number: <br /> �( �Ua <br /> SEPTIC TA K/HOLDINGTANK: <br /> Manuacturer. Liquid Capacity: Tan Inlet Elev.: Tank Outlet Elev.: Warning Label Locking Cover <br /> Pr Yesd NO Provided: <br /> �� F' ❑ ❑ Yes No <br /> Bedding: Vent aV .: Vent Matz High Water Alarm: NUMB RM Road: Property Line: Well: Building: Air Vent: <br /> '1 <br /> FEET FROM <br /> ❑ Yes No /j��!d'�c ❑ Yes No NEAREST-111, <br /> Llubili CHAMBER: <br /> Manufacturer: Be mg: Liquid Capacity: Pump Mo e : Pump/Sip on Manu acturec Hig WaterA arm Warning Lae Loc ing Cover <br /> ❑ Yes ❑ No Provided: Provided: <br /> ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No <br /> Ga ons Per betCycle: Pump an ontro sOperationa : NUMBER Property Line: We Bui ing: Air Vent: <br /> (difference between FEET FROM <br /> um on and off) Yes No NEAR EST--► <br /> Vent Insta e' <br /> Vent Diameter: Vent Materia : FORCE Lengt Diameter: Materia an Mar ing: <br /> VENT ❑ Yes ❑ No <br /> 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 /> BED/TRENCH Width: Length: No.Trenches: Latera Spacing: Cov r Material: Inscle✓D a No.Pits: Liquid Depth: <br /> DIMENSIONS 7_ i �G� PIT <br /> Gravel B low Pipe Fill Above;ipe: Inlet Elev.: En <br /> Elev.: Pipe Material No.Distr.Pipes: NUFEEMBER OF Property Line: Well: Building] Air Vent: <br /> �1�0.7 NEAREs°-i "? C / <br /> ELEVATION AND Manifold Lov.: Manifold Dia.: Mani old Material: No.Distr.Pipes: Distr Pipe Dia.: <br /> DISTRIBUTION /� --' �/ (�/r <br /> INFORMATION Hole Size: Hole Spa mg Drilled Correctly: Permanent Markers Observation Wel s: Pump Elev.: Vertical Lift Corresponds To <br /> ❑ Yes ❑ No ❑ Yes ❑ NoApproved Plans: <br /> MOUND SYSTEM: <br /> ❑ Yes ❑ No 1­1Yes ❑ No <br /> Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM <br /> slope and furrows thrown unslope mound systems to make certain that it ON REVERSE SIDE. SHOW <br /> ❑ Yes ❑ No meets the criteria for medium sand. ELEVATIONS MEASURED. <br /> ILC VER Texture: Permanent Markers O servation We s: <br /> ❑ Yes ❑ No ❑ Yes ❑ No <br /> Dept Over Trenc Be Center: Dept Over Trench Be Edges: Dept s0 Topsoi : So a Seedecj Mulched <br /> ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> COMMENTS:(Sketch System On Reverse Side) r' <br /> �r 4If l2 //. ✓�t� /r - �n <br /> io&�e ��_ C�nLGi��<9s /�'im,'f ,S/P✓/ �C'G��>a✓/c �6.'�p5' <br /> 4 <br /> Signature: - itz <br /> SBD-6710(R.09/90) (Keep a copy in your file for audit) <br />