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t ii &-4Cz /DCb <br /> DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS <br /> LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION <br /> P.O. BOX 7969 BUREAU OF PLUMBING <br /> MADISON,Vdl 53707 <br /> ONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number <br /> Holding Tank L1In-Ground Pressure L1 Mound (II asspnedl <br /> ATE <br /> NA=PET,HOLDERO I' INSPECTION N I �y,� kd / � —,3 — r :So <br /> BENCH <br /> MARK P,01.r0-1 P-11 DESCFI IF DIFFF,RENT FROM PLAN REE.PT.ELEv CSTREF.PT.ELEV.' <br /> A I 'r1 <br /> Name IT Plumbv. MEIMPR51N Nn Cou(rn � Samlary Pe�ml Number, v <br /> EW <br /> 11S (7 --UT(1 _)q7 �a7. <br /> SEPTIC TANK/ <br /> MANUFACTURER LIOUIDCAPACITY. T ANK INLET ELEV.. TANK OUTLET ELEV. WARNING LA EL LOCKING COVER <br /> j'� ycy PROVIDED. PROVIDED. <br /> 141 G r� S� ( /i y 5CYES ❑NO �❑�YES ❑NO <br /> BEDDING. VENTDIA.. VENT MATT HIGH WATER ROAD. Pfl OPERTY W BUIIIh,,C/� AENTTO FR ISH <br /> ,, ALARM p"a �Q / LINE ,A It 'wee <br /> AIR INLET <br /> DYES MIND CiR'�" ❑YES ❑NOx ))TT// <br /> DOSING CHAMBER: <br /> MANUTACTURER REDOING 110UIn CAPACITY PUMP MOOEL PUMP/SIPHON MA NUFACTURER WAR NINGL BEL LOCKING COVER <br /> PROVIDED'. PROVIDED. <br /> DYES ❑NO DYES ONO I ❑VES ONO <br /> GALLONS PER CYCLEPUMP AND CONTROLS OPERATIONAL CW, PROPERTY WELL BUILDING VENT TO FRESH <br /> (DIFFERENCE BETWEEN F t IT LINE AIR INLET <br /> PUMP ON AND OFF) 11 YES ❑NO <br /> SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing " ':IENC,TH JDIAMLTEII MATERI Al ANO MARKING <br /> or excavation. (if soil can be rolled into a wire,construction shall cease until f ,RE,�` <br /> the soil is dry enough to continue.) <br /> CONVENTIONAL SYSTEM: <br /> z WIDTH LENGTH l NO.OF DISTR.PIPE SPACING COVER .INSIDE Uln s ITS uCLID <br /> 4 Nf]''R H, (r [ TREN%HES MATE ALS `PIT DEPTH <br /> Qi E�y 3 <br /> (:RAVEL nFPTII FILLDEPTII I)ISiH 'IVF OI$TR.PIPE DISTR_PIPE MATERIAL NO DISTR 1 �1fF' PROPERTY WLL BUILDING VENT TO FRESH <br /> BE LOW PIPES ABOVE COiVE FI FV INltl ELEV ENU PIPE i LINE. AIR INLET <br /> i� /J 993 ���• � Fe�.. � <br /> MOUND SYSTEM: o(.• <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 /> meets the criteria for medium sand. TIONS MEASIL RED. <br /> OYES 1:1 NO <br /> SOIL COVER TPxIUHI PERMANFNT MARKERS OBSE IVATION WELLS <br /> El YES ONO 11 YES 0 N <br /> OFPi110VEH TNCNOI BCD DEPTH OVFH TRENCH 9FD OCPTH OE TOPSOIL S'ODDEO SEEDED MULCHED <br /> f FN1 FH EDGES <br /> _ ❑YES ❑NO ❑YES ❑N ❑YES ❑NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER <br /> d/�ppi TRENCHES <br /> MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL NO DISTR OISTR.PIPE DISTRIBUT ONPIPE MATERIAL&MAnKING <br /> . ELEV. ELEV. DIA ELEV. PIPES DIA <br /> Y VST <br /> S T it HOLE SIZE HOLE SPACING DRILL ED CORRECT LV COVER MATERIAL VERTICAL LIfT CORRESPONDS TO APPROVE <br /> �����EB.��F���a PLANSI-IT . <br /> "'-+":`..x ❑YES ❑NO YES ONO <br /> COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS a ^ > EVEPERTY WELL BUILDING. <br /> A*Q LIN <br /> L1 YES El NO ❑YES ❑NO <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> Fs FON <br /> URE TITLE <br /> / '1 <br /> DI LHR SBD 67101R.01/82) 1' <br />