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q-6-"�/ <br /> Wisconsin+�epartment Of Industry, ON SITE SEWAGE SYSTEM Safety&Buildings Division <br /> Labor and.Human Relations INSPECTION REPORT <br /> P.O. Rox 7969 County: / <br /> ZZ <br /> ison,WI 53707 Y �1�P� <br /> ///���CONVENTIONAL ❑AT-GRADE ElIN-GROUNDPRESSURE []MOUND ElHOLDING TANK <br /> EXPERIMENTAL ❑NEW ❑REPLACEMENT ❑RECONNECTION ❑OTHER(SPECIFY) <br /> Permit Holder's Name: Permit Holder's Address �Im �� I Inspection Date:7/61 <br /> r (,Jldai(►�(,j. <br /> Bench Mark,De nQ(�e�I DD ferent From Plan: Parcel Tax I_D.No.(Optional) Ref.Pt.Elev.: CST Ref.Pt.Elev.: <br /> Plumb is me: MP/MPRSW No.: State Plan ID No.(I Assigned): Sanitary Permit Number: <br /> 0 3561 8 <br /> SEPTIC TANK/HOL INGTANK: puril <br /> Manufacturer: r% Liquid Capacity: Tank Inlet Elev.: Outlet Elev: W nin Label Locking Cover <br /> rll %/7 /i__ O 9`./D cli3Oy� - e Provided: <br /> lN7 ,,[[ YJ es h o Yes NO <br /> Bedding: No vl/.: Ven��l.: High esteE]„Nom N ETR ROMA 7ar'X / 7/00/ e. 7,Z g: AirL <br /> DOSING CHAMBER: / <br /> Manipfacturer: Bedding: Liquid Caapacity: Pump Mo e : Pump/SiphonN/lams acturer. Ag WaterAarm Warning La a Locking Cover <br /> _T/VC ❑ Yes No /JQ zDe�/e�• Yes Provided: P�r9vided: <br /> ❑No Yes ❑No Qy.Yes ❑No <br /> Ga ons Per Cyc e: Pump and Controls Operational: NUMBERProperty Line I We : Bun ing: Air Vent: / <br /> (difference between FEETFROM / t <br /> um on and off) Yes No NEAREST--* ,,2J <br /> Vent Insta a Vent Diameter: I Vent Materia : FORCE Lent : Diameter: Materia an marking: <br /> Tn�, ) q <br /> VENT Yes ❑ No /T ,`40/V MAIN �/ O� /f <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/FRENCH Width: Length: No.Trenches: I Lateral Spacing: Cove Material: Inside Dia: No.Pits: Liquid Depth: <br /> DIMENSIONS /� �C7 �L/ '/ (> PIT <br /> Gravel low Pipe5 Fill Above Pipe: Inlet Elev.: En Elev Pipe Material No-Distr.Pipes: NUMBEROF Property Line: Well: Build in Air Vent: <br /> Lr FEETFROM t / q / <br /> �t /6 �y �ia7zq NEAREST y _JO S �6 <br /> Mani old Elev.: Manifold Dia.: Manifold Material: No.Distr.Pipes: Distr.Pipe Dia.: <br /> ELEVATION AND // 303 /V//(- <br /> DISTRIBUTION <br /> INFORMATION Hole Size: Hole Spacing: Drilled Correctly: Permanent Mar kers Observation Wells: Pump Elev : Vertical ACorresponds To <br /> Approved Plans: <br /> ❑ Yes ❑ No ❑ Yes ❑ No EIYes ❑ No /1�f 1� ❑ Yes ❑ No <br /> MOUND SYSTEM: <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 systemsto make certain that it ON REVERSE SIDE. SHOW <br /> ❑ Yes ❑ No meets the criteria for medium sand. ELEVATIONS MEASURED. <br /> Texture: Permanent Markers: Observation Wells: <br /> SOIL COVER <br /> ❑ Yes ❑ No 1 [3 Yes ❑ No <br /> Depth Over Trench Bed Center: Depth Over Trench Bed Edges: Depths OTopsoil: So a Needed: Mulched: <br /> ❑ Yes ❑ No ❑ Yes ❑ No I ❑ Yes ❑ No <br /> COMMENTS:(Sketch System On Reverse Side) /� <br /> Burke tle&6 7 <br /> z� 6 <br /> Signature: Title: <br /> (Keepa copyour file for audit) <br /> SBD-6710(R 09/90) <br />