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10 A-�(0 Y. 0-0 <br /> DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS <br /> LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION <br /> P.O.BOX 9969 BUREAU OF PLUMBING <br /> MADISON,WI 53707 <br /> CONVENTIONAL ❑ALTERNATIVE slate Plan LD.Numher. <br /> H.a.,�Rnaal <br /> ❑Holding Tank ❑ In-Ground Pressure ❑Mound <br /> NA"PERMIT HOLO R. ADDRESS OF PERMIT HOLDER. , ,/ INSPECTI N DATE <br /> ` NC hl, �� Illi _�J� &-2f-7' <br /> BENCHMARK Permanent refe-nee pmnn DESCRIBE IF DIFFERENT FROM PLAN REF.PT. LEV.. CST REF.PT.ELEV <br /> / <br /> Na 1 PI nLer. MP/MPRSW Nn. County SarulNry P­1 Number. - pp <br /> � �Y1� <br /> SEPTIC TANK/HOLOIN -T`"i <br /> MANUFACTURER LIQUID CAPACITY TANKINLETELEV TANK OUTLET ELEV WARNINC LABEL LOCKINGCOVER <br /> p i PROVIDE PROVIDED <br /> �pol+ /6 c�`lP I J� AYES ONO DYES ONO <br /> BEDDING. VENT nIA. VENL MnII HI(IH WATER NUMBEROF RO U PROPERTY W LL BURDINr. VENTTOFRESH <br /> ALnvM _ FEET FROM 1 n ` LINLr / AIR INLEr <br /> DYES NO T ❑VES LINO NEAREST ...���JJJ��� U <br /> DOSING CHAMBER: <br /> MANUFACTT V/R✓E�H BEDDING Llf)UII)1_APA[:IIY PII/MV Mf11�1/FL IIMP$IYHnN hinNIII AI:IUHE11 WARM GLABEL LOCKING COVER <br /> / l ❑YES ®NO �—T� / �/7 �� PRovlo o PaovlDEo. <br /> U� 1LGr°Sv- + <- 'Y S ❑NO YXYES ONO <br /> GALLONS PER CYCLE: PUMP AND coNTHOLs OPER TONAL :R Of: PRU1FRTv w.IL -P BORDINI. vEIN TO FRESH <br /> uNE EET FROM7 " AIR INLET <br /> (DIFFERENCE BETWEEN -} i7� AA _t VES ❑NO NEAREST---i 7 A Z' <br /> PUMP ON AND OFF) � l'L` - 'L� <br /> SOI L ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing nNlm rnnME TER MAn IAL AND MAvxmo <br /> or excavation. (If soil can he rolled into a Wire,construction shall cease until FORCE ` / // • //- <br /> the soil is dry enough to continue.) MAIN 4 <br /> CONVENTIONAL SYSTEM: <br /> BED/'Fdik`N�C�FI w1otH LENGTH No DF Dlsnv vL svnrlNl, coVEEI INsml IRA =Pill LOum <br /> I IHFNoo-s Mn1ErnAc PIT Deeny. <br /> DIMENSIONS ( �� a <br /> A L PT" FILL DEPTH 1)15111 PII`h UISTN PIPL DISTR PIPE MGTERIAL N(1 ORill N' ER Of PROPERTY WELL BUILnING VENT TO FRESH <br /> BELL.PIPES/ ./ AED COvAH ETI NLIr ELEV LNu PIPL\ FEET FROM LIN C AIR IrvLEr <br /> c� 9q i yy _ v`c 3�z� NEAREST_-=--• mak' �; V <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 REVER 3E SIDE.SHOW ELEVA- <br /> meets the criteria for medium sand. TIONS MEASURED. - <br /> DYES ONO <br /> SOIL COVER Ti PI HMnw NI MnuKI Is L BSE HVA T nN wE I LS <br /> LIVES 11 NO 1 _DYES 1:1 NO <br /> DEPTHnvFR TRENCH DEC .11111 1111 R TRE NOI RE U urP ill Dl rTPsnR $nuuFn sFEDru MULCHED <br /> CENTER EDGES <br /> ❑ ❑ <br /> ❑VES. NO VES NO 11 YES El NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> WIDTH LENUTH NO OF LATFRALSPACIN6 GHAVEL nEPTHHFLDWPIPI FILLD PTHABOVECOVEH <br /> BED/TRENCH. . TRENCHES <br /> DIMENSIONS L... <br /> ' MANIFOLD PUMP MANIFELII DISTR.PIPE MANIFOLD MATERIAL NIFUISTH DISTH PIPE DISTHI UHnN PIPE MATERIAL&MAHKING <br /> V. <br /> ELEV. ELEV DIA ELEPIPES UTA <br /> ELEVATION AND <br /> DISTRIBUTION r <br /> INFORMATION HOPE SIZE HOLE SPACTNO DRILL Lu LOGRICI L Y LOVER MATERIAL VVEAHII'At LIE T CORRESPONDS TO APPROVED <br /> NE <br /> DYES ONO I DYES [:]NO <br /> COMMENTS: PERMANENT MARKERS OBSERVATIONWELL$ NUMBEROF LROEERTV Wf LL. BUILDING. <br /> FEE FROM <br /> DYES ONO ❑VES 0N _ NEAREST .. <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> SIC ATURE TITLE <br /> DILHR SBD 6710 (R.01/82) - � <br />