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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 Bate Plan I.D.Number <br /> Ut.aa�anedl <br /> ❑ olding Tank ❑ In-Ground Pressure ❑Mound <br /> NAOF PERMIT HOLDER: P.ODR ESS OF PE IT HOLDER: INSPECT( N DATE: <br /> CiLLj� Lud iZ �A3o <br /> BENCH MARK(Permanent reteren point)OESCRIB^IF DIFFERENT FROM PLAN'. flEF.PT. LEY.: CST REF PT.E LEY.: <br /> Name of a Oer: MP/MPRSW Na.: County Sanitary P irmin Number. <br /> r l0 333 <br /> SEPTIC TANK/HOL ING TANK: <br /> MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNIN LABELLbUILUI�1: <br /> PROVIDE <br /> ❑Y S ONO OYES ONO <br /> BEDDING: VENT DIA.: VENT MAIL. HIGH WATER NUMBER OF ROAD'. PROPERTY ELL. TO FRESH <br /> ALARM. FEET FRDMLINE LET: <br /> .YES ❑NO DYES ❑NO NEAREST <br /> DOSING CHAMBER: <br /> MANUFACTURER: BEDDING: LIQUID CAPACI TY: PUMPMODEL: PUMPISIPHON MA NUFACTURER. WARN( I <br /> IG LOCKING COVER <br /> PROVI ED' PROVDED: <br /> OYES ONO ❑Y S ❑NO OYES ONO <br /> GALLONS PER CYCLE: PUMP AND corvrfloLs ovERATIONAL: NUMBER OF LMEERTV ELL: BUILDING: V NT TO FRESH <br /> (DIFFERENCE BETWEEN <br /> FEET FROM AIR INLET: <br /> PUMP ON AND OFF) ❑VES ONO NEAREST <br /> SOIL ABSORPTION SYSTEM.Check the Soil moisture at thedepth of plowing LENGTH'. DIAMETER: MATE IAL 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 /> WIDTH ,-1 LENGTH: I NQ.OF DISTR P PE PACING: OVER INSIDE DIA.. #PITS: LIOUID <br /> BED/TRlP1YH )N[ q TRENTES: MATE AL: PIT DEPTH'. <br /> DIMENSIONS !j ` J1 <br /> RAVEL DEPTH / FILL DEPTH DISTR PIPE DISTR.PIPE DISTR.PIPE gL,ATERIAL: NO DISTR. NUMBER OF PROPERT WELL' BUILDING'. V NT TO FPESH <br /> BELOW PIPES'//,, ABOgVE OYER'. ELEV IpryL L ELEV.END'. T t% PIPFrY FEET FROM LIy/I r a71 A/O� ^Iq INTI <br /> V/ J ! 7P 9 , L •ll'y/ J NEAREST-► ocU �.Y� '7 '/7/3 <br /> MOUND SYSTEM: <br /> Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE DIAGRAM OF SYSTEM <br /> and furrows thrown upslope: mound systems to make certain that it ON REVE SE SIDE.SHOW ELEVA- <br /> meets the criteria for medium sand. TIONS MEASURED. <br /> OYES 0N <br /> OIL COVER TEXTURE. PERMANENT MARKERS: BSERNATION WELLS. <br /> OYES ONO 1:1 YES ONO <br /> DEPTH OVER TRENCHIBED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED. SEEDED. MULCHED'. <br /> CENTER. EDGES: <br /> ❑VES F-1 No DYES DNO DYES ONO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> WIDTH: LENGTH'. NO.OF LATERALSPACING: GRAVEL DEPTH BELOW PIPE. FILL EPTH ABOVE COVER'. <br /> BED/TRENCH TRENCHES: <br /> DIMENSIONS <br /> MANIFOLD PUMP MANIFOLD Dem.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR. IPE DIST IBUTION PIPE MATERIAL&MARKING <br /> : <br /> ELEV.'. ELEV.. DIA.'. ELEV.: PIPES: DIA.: <br /> ELEVATION AND <br /> DISTRIBUTION HOLE 512E HOLE SPACING: DRILLED CORRECTLY. COVER MATERIAL: VER (CAL LIFT CORRESPONDS TO APPROVED <br /> INFORMATION PLA S. <br /> ❑YE ONO DYES ❑NO <br /> COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: <br /> FEET FROM LINE: <br /> DYES ONO DYES ONO NEAREST <br /> Jic«2- ;rl <br /> Sketch System on Retain in county file for Bud t. <br /> Reverse Side. I LE' <br /> SIG TLE'. �. <br /> D I LHR SBD 6710(R.01/82) <br />