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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,WI 53707 <br /> CONVENTIONAL El ALTERNATIVE sale Plan 1.D.Numbe,'. <br /> ul a,�IRae�I <br /> ❑Holding Tank ❑ In-Ground Pressure ❑Mound <br /> No PERMIT HO DE L/F'[✓~'— ADORESS OF PEROLDER'.� �/ 5��.3V INSPECTJ(jN=ATF, <br /> BENCH MARK IPer,1ana�. reC,00,11)DESCH IBE I F DIFF ER ENT FROM PLAN. 77 REF.P�Tj/E]LEV..�� CST REF.PT.ELEV <br /> b <br /> / i[l 1�l f0 ex,� <br /> Name 01 Plumber. MP/MPRSW N0. Coum Samtary Parma Number. <br /> o3�s9 64/97 (/aoy3 <br /> SEPTIC TAN / 1K: <br /> MANUFACTURER _ LIGUIO CAPACITY TANK INLET ELEV. TANK OUTLET ELEV WARNING LABEL LOCKING COV ER <br /> 7�7n PROVIDED. PROVIDED <br /> j3YES [:]NO ❑VES [!]NO <br /> BEDDING VENT DIA.'. VENT MATL HIGH WATER UMBER OF ROAD: PROPERTY WELL BUILDING VENTTOFRESH <br /> A ALARM FEET FROM / 1 q� x IAIR INLET <br /> DYES O CLQ. OYES LINO NEAREST z L/ l 0 <br /> DOSING CHAMBER: <br /> MANUFACTURER BEDUING LIQUID CAPACITY PUMPMOUEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER <br /> PROVIDED PROVIDED. <br /> DYES ❑NO DYES ❑NO DYES ❑NO <br /> GALLONS PER CYCLE: PUMP AND corvTRaLs oPERAnorvAL. NUMBER OF PHOPERTY weu BUILDINH VENTTO <br /> AIR <br /> FRESH <br /> (DIFFERENCE BETWEEN FEET FROM LINE AIR wT. <br /> PUMP ON AND OFF) ❑VES ❑NO NEAREST <br /> SOIL ABSORPTION SYSTEM.Check the soil moistureat thedepth ofplOwing LENGTH n1AMETER MATFHIAL AND MARKING <br /> or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE <br /> the soil is dry enough to continue.) MAIN <br /> CONVENTIONAL SYSTEM: <br /> ,. y� w or LENCTH No of DIsrR PIP sPAarvc covER INSIDE DIA nPlrs uoulb <br /> BED/ree�n5.n a / TRENCHES MATS PIT DEPTH. <br /> DIMENSIONS <br /> GRAVEL DEPTH Fi LL DEPTH UISTH PIPE DISTR PIP DISTR.PIPE MATERIAL NO.OISrR. NUMBER OF PROPERTY WELL. / BUILDING'. VEnN TOE FREE <br /> BELOWPIPE N ABOVE GOV ELEV INLET ELEV.E,rvtO� �/ PIPES FEET FROM L DS / •(` J <br /> d'/F P I//� Y NEAREST w 6� <br /> MOUND SYSTEM: <br /> Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM <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 MEASURED. <br /> EYES ❑NO <br /> SOIL COVER TEXTURE PERMANENT MARKERS. OeSFR NA TION WILLS <br /> EYES ONO ❑YES ❑NO <br /> DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL SODDEDSEEDED MULCHED <br /> CENTER EDGES <br /> ❑VES 1:1 NO ❑VES ❑NO DYES 1:1 NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> WIDTH LENGTH NO.OFLATERAL SPACING. GRAVE L DEPTH BELOW PIPE FILL DEPTH ABOVE COVER <br /> BED/TRENCH TRENCHES. <br /> DIMENSIONS <br /> MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLDMATERIAL NO UISTH. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. <br /> ELEV. ELEV. CIA. ELEV. PIPES DIA.. <br /> ELEVATION AN <br /> DISTRIBUTION HOLE 54E HOLE SPACING DRILLED CORRECTLY COV OVER MATERIALPLANS <br /> . VERTICAL LIFT CORRESPONDS TO APPROVED <br /> INFORMATION <br /> DYES ONO DYES ONO <br /> COMMENTS: PERMANENT MARKERS'. 005ERVA I ION WELLS FEETNUM13EROM PROPERTY WELL. BUILDING. <br /> FEET FROM urvE. <br /> DYES ONO ❑VES ❑NO NEAREST <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> 51 TURF. TITLE. <br /> DI LHR SBD 6710 (R.01/82) <br />