Laserfiche WebLink
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 /> XCONVENTIONAL ❑ALTERNATIVEStade elan 1.0 Number. <br /> Ll Tank ElIn-Ground Pressure ❑Mound IHa P", l <br /> NAME OFPE IT HOLDER. PERMIT HOLDER s!/D� INSPECTION DATE <br /> B NCH MARK anemrelrrenceP-11 DESCRIBE IF DIFFERENT FROM PLAN AEF.PT.ELEV.'. CST REF.PT.ELE V. <br /> Name nl Plumber. MP <br /> N. CoumY SamtarY Permrl Number. <br /> /;�/� % o/3 G //�73 <br /> SEPTI ANK/RbEVMe-T W: <br /> MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCK(NG COVEfl <br /> PROVIDE D PROVIDED <br /> /� (7 Ip YES ❑NO VES ❑NO <br /> BEDDING. VE VENT MAIL.J HIGH WATER NUMBER OF AD. `/ROEERTV WELL 7 BUILADING. 'VENT TOFSH <br /> 11 ALARMFEET ��jj q y I —J.IIq IR INL)•..I <br /> [:]YES NO 7/ EYES END NEARESTOM o(J <br /> DOSING CHAMBER: <br /> MANUFACTURER BEDDING LIOLIU CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURE WARNING LABEL LOCKING COVER <br /> �,/ y[,�T /D PROVIDED. PROVIDED. <br /> a'a� [:]YES [&0 / `� v 1 MMES ❑NO XYES ENO <br /> GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTYwELL BUILDING VENT TO FRESH <br /> (DIFFERENCE BETWEEN / FEET FROM LINE 7.� / AIR!11rvLtEj� <br /> PUMP ON AND OFF) / d VES ❑NO NEAREST (/ a0 oe✓ <br /> SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plOwi ng LENGTH +,, DIAMFTE,R MATERIAL AND MARKING <br /> or excavation. (If soil can be rolled into a wire,cbnstruction shall cease until FORCE <br /> the soil is dry enough to continue.) MAIN <br /> CONVENTIONAL SYSTEM: <br /> WIDTH LENGTH NO.OF DISTR PIPE SPACING COVER INSIDE DIA. 4pIT5 LIQUID <br /> BEDENSIONH n 36 <br /> TRE CHEs MAT IAL <br /> DIMENSIONS <br /> �L PIT oEPTH. <br /> GRAVEL DEPTH FILL DEPTH UISTH PIPF DISTR.PI E DIBTR.PIPE MATERIAL NO.DIS NUMB ROF PROPERTv WELL. BUILDING V NT TO FRESH <br /> BELOW PIPE ABDV EOC O�ER ELEV INI.Fr ELE V.END C PIPES FEET FRDM LINE j � L'�fJ AIR INLE/. <br /> O/e^/, 2 6 _ �- NEAREST J(/�J D <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 upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- <br /> ❑VES ❑NO meets the criteria for medium sand. TIONS MEASURED. <br /> SOIL COVER TEXTURE PERMANENT MARKE HS OBSERVATION WE LLs <br /> ❑VES []NO DYES LINO <br /> DEPTH OVER TRENCH:BED DEPTH OVER TRENCH;BEL) DEPTH OF TOPSOIL SODDED SEEDED MULCHED <br /> CENTER EDGES <br /> ❑VES ❑NO ❑VES ❑NO EYES LINO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> BED/TRENCH WIDTH LENGTH NOENCHESO OF . LATERAL SPACING GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER <br /> DIMENSIONS <br /> MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING <br /> ELEVATION AND <br /> ELEV. ELEV. DIA. ELEV. PIPES Dlgc <br /> DISTRIBUTION <br /> INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED <br /> PLANS <br /> EYES ❑NO [!]YES ❑NO <br /> COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING. <br /> FEET FROM LINE <br /> - <br /> DYES 1:1 No DYES ❑NO NEAREST <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> SIT RE E <br /> v �j <br /> DILHR SBD 6710(R.01/82) <br />