Laserfiche WebLink
UI I <br /> DEP 0,RTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS <br /> LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION <br /> P.O.BOX 7969 BUREAU OF PLUMBINC <br /> MADISON,WI 53707 <br /> CONVENTIONAL Ll ALTERNATIVE state Plan LD.Null",ne��l <br /> ❑Holding Tank 1:1 In-Ground Pressure ❑Mound m <br /> NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE <br /> 11ENCH MARK Permanent refer¢ epomtl DESCRIBE IF DIFFERENT FROMPLAN. REF.PT.ELEV.'. CSTREF.OF EELEV <br /> is SLP �t <br /> 7/1 L <br /> Name of Plumber ^ MPIMPgSW No.. County S/nitary Perm/it Number. <br /> �a A9 <br /> SEPTIC TANK/ DING TANK: <br /> MANUFACTURER. LIQUID CAPACITY TANKINLETE EV TANK OUTLET E LEY.. WARNING LABEL LOCK ING COVER <br /> (� 9 PR OVIDED. PROVIDED. <br /> 6eZ Z-Ii'L/ �e X �.J + D.L r 6 VES ❑NO [:]YES ❑NO <br /> REDOING'. VENT DIA. VENT MATL. HALGAHRMA ER NUMBER OF ROA 4 PROPERTY WELL BUILDING VENTTE FRESH <br /> 4 FEETFROM D f - uNE RT l�l hlIAIRINLET. <br /> ❑VES NO ❑VES ❑NO NEAREST G U <br /> DOSING CHAMBER: <br /> MANUFACTURER BEDDING. LIOVID CAPACITY PUMP MO PUMP,OPHON MANUFACTIIRER WgRNING LABEL LOCKING COVER <br /> PROVIDED. PROVIDED. <br /> [!]YES ❑NO DYES ❑NO []YES ❑NO <br /> JTO <br /> GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BOILDIAc VENTLE FRESH <br /> (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET <br /> PUMP ON AND OFF) DYES [!]NO NEAREST <br /> SOIL ABSORPTION SYSTEM.Check thesot moistureat the depth of plowing LENGTH DIAMETER MATERIAL ANDMARKING <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 /> BED/TRENCH WIDTH �j f LENGTH NO,OOF DISTR/PIPE SPACING COVER INSIDE YA. *PITS L QUID <br /> DIMENSIONS / Lf j TRE/cHES (p MArEgII L: PIT DEPTH. <br /> GRAVEL DEPTH FILL DEPiH DISTR PIPF DISTR PIPE DISTR.PIPE MATERIAL. NO.�OfI Si NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH <br /> BELOWPIPE ABOVVIIVVER ELEV.Iry LET ELEv END �i PIP11 FEET FROM LINE 1 P AIR Ey <br /> J /6 /o. ! � J NEAREST <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 /> ❑VES ❑NO meets the criteria for medium sand. TIONS MEASURED. <br /> SOIL COVER TEXTURE PERMANENT MARKERS. OBSERVATION WE LLS <br /> ❑VES 1:1 NO DYES ❑NO <br /> DEPTH OVER THENCH:RFD DEPTH OVER TRENCH:BED DEPTH OF TOPSOIL SODDED SEEDED MULCHFD <br /> CENTER EDGES <br /> EYES 0N ❑YES ENO 1:1 YES E-1 NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> BED/TRENCH WIDTH LENGTH TRENOCMEB LATERAL SPACING GRAVEL DEPTH BELOWPIPF FILL DEPTH ABOVE COVER <br /> DIMENSIONS <br /> MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING <br /> ELEV.. ELEV. DIA ELEV.' PIPES DIA.'. <br /> ELEVATION AND <br /> DISTRIBUTION <br /> INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED <br /> PLANS <br /> 1-1 YES LI NO Ll YES 1:1 NO <br /> COMMENTS] PERMANENT MgRKERs. OBSERVATION WELL&. NUMBER OF LINE TV WELL BUILDING'. <br /> FEET FROM LINE <br /> L1 YES 1:1 NO 11 YES 11 No NEAREST. <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> SIG T RE TIT.LLEE. <br /> DI LHR SBD 6710 (R.01/82) 0✓/��r�L�'--� tI�JL�/Lft!'�G.s''1`-' <br />