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DEPARTMtNT OF_I NOUSTRV, 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 S,alea Plan 10Number <br /> a^b <br /> ❑Holding Tank ElDI <br /> In-Ground Pressure ❑Mound - <br /> NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER: INSPECTION DATE <br /> BENCH MA 9 Mermanem reference pones O ESCCR I BEiI FAD I F F E R E NT F R OM P LANREF.PT.ELEV. SEGEL AT EL <br /> Name of PlumM1er. L-!i[, - (�Cou L� t Za <br /> Senuary Permit Number. <br /> x� fla 33 r 300 <br /> SEPTIC TANK/M A <br /> MANUFACTURER. LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV.. WARN:NG LABEL LOCKING COVER <br /> PROVIDED. PROVIDED. <br /> YES ❑NO EYES LINO <br /> BEDDING. VENTDIA. VENT MATL.. HIGH WATER NUMBER OF ROAD. PROPERTY WELL. BUILDING. I VENTTO FRESH <br /> L dt ALARM FEET FROM t / t.. INE. Aw Iry LET <br /> ❑VES NO I-y C�� ❑YES ❑NO NEAREST LJ� J <br /> DOSING CHAMBER: <br /> MANUFACTURERBEDDING LIDVID CAPAG (1 <br /> rY PUMP MDE1 PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER <br /> �t PRO IDED. PROVIOEP. <br /> DYES NO Z We 3 L /L-�L -ee;ej YES LINO DYES ENO <br /> GALLONS PER CYCLE: PUMP AND CONTROUSIOPERATIONAL NUMBER OF PROPERTY WELL auuDINU VENTTOFRESH <br /> / / AIRINLET! <br /> PDUIMP ON AND OFFBET1yEENS n-S YES ONO NEARES I FEET FROM LIN � ! / <br /> SOIL ABSORPTIONSYSTEM. heck the soil moisture at the depth of plowing LENGrH DIAMETER MATERIAL AND MARKIN('; <br /> or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE 'l _ 'y <br /> the soil is dry enough to continue.) �J <br /> CONVENTIONAL SYSTEM: <br /> WIDTH Lf NGTM NO.OF DISTR PIPE SPACI N(: COV INSIDE DIA SPITS LIQUID <br /> BED/1R�ENCM-� / / TREN HEs M E IAL'. PIT DEPTH <br /> DIMENSIONS 35 �Q— / <br /> IiFAVELDEPTH FILLDEPTII VISTA PIPE U6TH PIPE OIBTR PIPE re ERIAL N 'S NUMBER OF P RTV WELL. I- BUILDING VENT TO FRESH <br /> BELOW PI PE ABOVE COV ELEV IN <br /> ELEV EN PIP IPI AIR INLET <br /> n ElF' �j FEET FROM / <br /> 1� °"' J /Jy � P ��, NEAREST ► �d �-5� -rC-1 <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 REVE RSE SIDE.SHOW E LEVA- <br /> meets the criteria for medium sand. TIONS MEASURED. <br /> El YES 1:1 NO <br /> SOIL COVER TC.TUHF PEHMANFNI MAHKEHS OBseRVAnDN wE us <br /> _ <br /> DYES ENO _❑YES 11 NO <br /> DEPTH OVFR TRENCH;BED DEPrHDVFRTRENCH.BED DEPiH OF TOPSDII 5l1DDfD EEEDFD MVLCIIfU <br /> CENTER EDGES <br /> ❑YES 1-1 NO DYES FJ NO ❑YES <br /> ❑NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> BED/TRENCH WIDTH LENGTH NO OLHEs LATERALSPACIN(; (;RAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER <br /> DIMENSIONS <br /> MANIFOLD PUMP MANIFOLD DISTR PIPE MANITOLD MATERIAL NO DISTR DISTR PIPE UISTHIBV I ION PIPE MATERIAL &MARKINU <br /> FEV ELEV DIA ELEV. PIPE$ DIA <br /> ELEVATION AND <br /> DISTRIBUTION <br /> INFORMATION HOLE SIZE HOLE SPACING DHILLEDCORIIECILY COVER MATERIAL VERTICAL UFT CORRESPONDS TO APPROVED <br /> PLAN <br /> EYES ENO EYES 1:1 NO <br /> COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS. NUMBER OF PROPERTY UILOING. <br /> FEET FROM LINE. WELL. B <br /> ❑VES 1:1 NO 11 YES ❑NO NEAREST <br /> Sketch System on ` Retain in County file for audit. <br /> Reverse Side. <br /> 51G TITRE TITLE <br /> _ <br /> D I L H R SBD 6710 (R.01/82) <br />