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DEPARTMENT OF INDUSTRY, a 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 ❑ALTERNATIVE Slale Plan 1.D.Numl,er. <br /> ElHolding Tank 11In-GroundPressure L-1 Mound n.W.,F.1 <br /> NAM OF PERMIT HOL ER. ^ ADDRESs OF PERMIT HOLDER �D INSPECTION DATE <br /> B NCH MA IPermanem rek,. cepomHI DESCRIBE IF DIFFERENT FROM PLAN REE PT.ELEV.'. CST REF.PT.ELEV <br /> Name oI PI—E.. MPIMPR5W N11 Cnur�iy Sanitary Pe-1 Numaer. <br /> 1)3 05j 79675 t1as73 <br /> SEPTIC TANK"40tBINQZAA K: <br /> MANUFACTURER LIQUID CAPACITY TANKINLEI ELEV TANK OUTLET ELEV WARNING LABEL LOCKING COVER <br /> -7 (�,�/ ( P OV ICED PROVIDED <br /> C /✓�Z� % / ` J� YES ❑NO DYES ON <br /> BED ING. VENT DIA.. VENT MIrII IllIiII WPTFfI NUMBER0 ROAD ,� ! PROPERTY WELL BUILDING VENTTOFRESM <br /> ALARM FEET FROM ,r/ [� LINE. � �� AIR IrvLET. <br /> ❑YES NO DYES [:]NO NEAREST d� J <br /> DOSING CHAMBER: <br /> MANUFACTURER BEDDING LIDIIIII I'.APA(:III PUYIP11111111 PUEP.5IIIIONMM1NIIIM1 CT1111EII WFARIN LABEL LOCKING COVER <br /> PROVIDED PROVIDED <br /> [:]YES ONO [-]YES ❑NO [-]YES ENO <br /> GALLONS PER CYCLE: vBMP ANO CONTROLSOPERATIQNAL N )MISER`OF. PHOPELF, wFLL BUILDIN(I VENT TO FRESR <br /> (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. <br /> PUMP ON AND OFF) OYES ❑NO NEAREST'.—ir <br /> SOIL ABSORPTION SYSTEM.Check thesoil moistureat the depth of plowing FORCE n NOTn IIAM11u1 MATH H141 ANO MAHKINI, <br /> or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN. <br /> the soil is dry enough to continue.) <br /> CONVENTIONAL SYSTEM: <br /> BED/TRENCH w1DTH LENOTH No Of D151H vivE spnrlNL covFH RIA' PIT 1N11I1L Illn DEPTH <br /> nPns LIQUID <br /> ". rHE Nclas MAR <br /> DIMENSIONS. <br /> GRACE LOEPTH FILL DEPTH 1115111 PIPf UISLH PIPE DISTR PIPE MATERI4L NO nSIH NUMBER Qf' PNOPERTV WELL BUILDING VENT TO FRESH <br /> BE LOw PIPES ABovE covEH EIEv 1NI11 ELEV ENu P1Pfa FEET FROM LINE AIR INLET <br /> NEAREST—► <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 P 11m1AN1 N1 x+ANK f 1a oRSEHVAnnN WI LL <br /> _ ❑YES ONO _❑YES ONO <br /> DEPTH OVER TRENCH eED D EPTH OVF H THEN(I]BE U III PIH pI 1Up511IL 5I11tUf 11 JEIOIP MULCHFD <br /> CENTER EDGES <br /> ❑YES. ❑NO 11 YES 1_J NO DYES ONO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> WIDTH LENGTH O OF LATEHALSPACINLHAVEL DEPTH HI LOW PIPI FILL DEPTH ABOVE COVER <br /> -BEDITRENGN.> rNBENCHES G <br /> .DIMENSIONS <br /> MANIFOLD PUMP MANH(1LD DISTR PIPE MANIFOLD MATERIAL NO OISTH DSTH PIPE OISTHIBUT ION PIPE MATERIAL&MARKING <br /> ELEVATION AND <br /> ELEV. ELEV DIA ELEV. PIPES DIA <br /> DISTRIBUTION <br /> INFORMATION ' HOLE SIZE HOLE SPACTNo Of a LLE D GnHHFL11v COVER MAT FETAL VERTICAL L IF T CORRESPONDS TO APPROVED <br /> PLANS <br /> OYES ❑NO ❑YES LINO <br /> COMMENTS: PERMANENT MARKERS OBSERVATION WELLS NUMBEROF - PROPERTY WELL BUILDING. <br /> FEET FROM LINE. <br /> ` ❑YES 11 No LIVES 1:1 NO NEAREST— <br /> /7f„-�� <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> SIGIyA �j �///� TILT L/Eq� <br /> DILHR SBD 6710 (R.01/82) <br />