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05/18/2005 08:06 3492166 B C ZONING PAGE 06 <br /> ,DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY a,BUILDINGS <br /> LA9bF1 it HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION <br /> P.O.BOX 7919 BUREAU OF PLUMBING <br /> MADISON,WI 75707 <br /> - 131 CONVENTIONAL E ALTERNATIVE sale n..l.D. <br /> n/Mlieneol <br /> Q Holding Tank ❑In-Ground Prepure D Mound <br /> NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDERt 285 E. WentworthAve. INSPECTION DATErp <br /> Olsen, Thomas/Montez, Mary W. St. Paul MN 5 ,118 <br /> UNITIZWK RYIIR111 A,Flm- lj DeWflijelt IP OIPFF.RF,NT FROM P1•AN: REP..M.eLeV.: REP.FT.SLIM.! <br /> I�iR f <br /> n MPIMPRfW NO.: County: Y^^�'T tt Nvmeel: <br /> ' I <br /> Hopkins 03059 Burnett 91164 (12940 <br /> PTIC INO TANK: <br /> tLIQUID CAPACITY: TANK INLET E V.: TANK OUTLET FLEV.: L IN V N <br /> r tRYES ❑NO ❑YE <br /> eEDINNO: VENTOA.f TL: m rY II <br /> t} MY FRED" <br /> LARM: 111111111T FROM �l„� uNEr / 1 ., AIR INI I�: <br /> YES O tam YES ❑N NEA EST r ✓ � ti ` I <br /> I <br /> JALONSPEIR <br /> HAMBER:: t LIQUID CAPACITY: PUMP MODEL: PUMPINIPH ANUF IMEfl: WARNINGL KIN• e /�7'/ PRo IDED: FRGVIOF.O; <br /> �YE O �'� k. �.o ( YE5 ❑ YES <br /> NTROLS OPE AL: NUMBER OF PROFEATV WELL_ ILDINu: vtN 'U 1 <br /> NCE BETWEEN FEET FROM LINE' /'ND OFF) Y S ❑NO NEARESTORFTIQN'Y$TEM.ChEcktheEoflmoistureEtthe pthofplowirlq LENC. H: 21AM TRI: [TCRIALANDMARKINor excavation. (If soil tan be rolled into a win,construction ShNI came until FORCE , f I :soil IE dry enough 1W continue.) MAlN '� �' r:,-'•... <br /> M- <br /> I ENOTH: NO, OISIH.FIPESPACING: INSIDE DIA.: !!PITA: LIQUID <br /> B[D/TR[NCH +L( TRENCHES: I AT AL' PIT � OEFTH;' r <br /> DIMENSIONS T 6 "�� <br /> Av N L I� 1 n I 11.rP'C OISTR.PIPE .PIPE MATE IAL: NV.DISI II, LL: : V T TO <br /> BELOW PMEf: COVE IR: LSV.INLET:ELFV,END: PIPIT FEF„T'E LICE: / / �/ AIR INI.I. <br /> IT 7� "J NEAREST r O o �Sp <br /> MOUND SYSTEM; <br /> Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM <br /> and furrows thrown upslopes mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- <br /> ❑YES ❑NO meets the criteria for medium send. TIONS MEASURED. <br /> V[Ru L: r RMANENTMARKE : DeSER A WELLS: <br /> DYES FIND OYES 0 NO <br /> ut&P IN OVER DEPTH own tV DEF HOG TOPSOIL: DDED: NEEDED: ULMI <br /> ClNTER: EOOEE: <br /> ❑YE 0 [:]YES NO EYES ONO <br /> FRRSSURi2[D DISTRIBUTION SYSTEM: <br /> L NOTH• O.OF LOW PIPE: FILL Oi n/Vr .UVI;N: <br /> BBD/TRENCH TRENCHES: <br /> DIMENSIONS <br /> MANIFOLD PUMF MANIFOLD 011TH.PIPEMANI OL INC.DIST .F IUP PIPE MA AL R MARKIN : <br /> [LlVATION AN <br /> F,LEV.1 ELFv.; DIA.: ELEV.: PIFES+ GIA,; <br /> DISTRIBUTION <br /> INFORMATIONL sere: oCF111110—N—I DRILLE13 RECTLY: COVERM TERIAL: V FLANS: cO OS'n;APPRDv. <br /> O <br /> YES ❑Y[S ❑N <br /> CQMME : PE A KL'RS: OME"AnCN LLS: NUMBER OF LFNQIF.RTY W LL: <br /> A F`[T FROM <br /> ❑Y ❑NO ❑YES ONO NEAREST <br /> ` � p� • 0142 SySfe1� gp.d�- <br /> �l1!+aT <br /> �o TMEdC flw To»s dkc <br /> l,Q cua'�+cr 'w (brcra�e iti �io�cs. <br /> �8 <br /> Sketeh Syetilen an Retain in County file for audit <br /> Reverse Side. <br /> I0MATUR : I <br /> DILHR SED 07110(R.01/62) <br />