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B erl a . 0/1a/8 <br /> 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,W1,53707 ' ,{ <br /> D4CONVENTIONAL ❑ALTERNATIVE sale Plan 1.D.N.mBe1. <br /> ❑Holding Tank ❑ In-Ground Pressure ❑Mound <br /> NAME OF PERMIT HOLD 4sAee AODRE OF PlillERMIT HOLDER�� /�� �N INSPFCTX�ATE -a -�6 <br /> BENCH MARK We,man ,l cele• ce poinD DESCRIBE IF DIFFERENT FROM PLAN ul^J1 REF.PT.ELEV.1 CST nEF.PT.ELEV <br /> a / <br /> Nam I Plumbe,. MP/MPRSW All CH"', Samle•y Pe•mn No LE•'. eu <br /> Rod No kl,vS 10115 urrL /q 7 0 3 <br /> SEPTIC TANK/ NK: <br /> MANUFACTURER. LIQUID CAPACITY TANK INLET ELEV TANK OUTLET ELEV WARNINGLABEL LOC KING COVER <br /> ' <br /> FEE <br /> PROVIDED <br /> FL. XYES ❑NO ❑YES ONO <br /> BEDDING. VENT DIA. VENT MAl l 1"11,H WATER 5 NUMBER OF To PR OPERTV WEyL' y BU GOING. VENT TO FRESH <br /> ALARM FEET FROM f u i / / AIR INLET <br /> ❑YES XNO ❑VES ❑NO NEAREST •: ll / �"C %C�`` <br /> DOSING CHAMBER: <br /> MANUFACTURER BEDDING LIOIIIII I APAUty PUMPVIIIAE PIlMP.51PHLlN MANIL ALIURbi WARNINGLABEL LOCKINGCOVER <br /> PROVIDED' PROVIDED. <br /> DYES ONO : YES ❑NO ❑VES <br /> ONO <br /> GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPE I, wFLL BUILOINI, vNT TO FRESH <br /> (DIFFERENCE BETWEEN FEET FROM -'> LINE AIR INLET. <br /> PUMP ON AND OFF) DYES ❑NO NEAREST-0r <br /> SOIL ABSORPTION SYSTEM.Check the soil moistureat thedepth ofIowln C IINI,nI UTAA1F111' II FOA' AND MAHKIN', <br /> GTE 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 LENGTH ND M DISIH v1Pf svAl INF <br /> lovfH wsuL uIn cPI rS uaulD <br /> BE ENSIO S ,� T'ENE: IS MnfFHlnv. PIT DEPnI <br /> DIMENSIONS J G^ <br /> RAV LDEPTH FILL DEPTH 1115111 PIPf UIS1H PIPf DISTR PIPF MATERIAL NO nIGI NUMBER OF PROPERTY WSL,L BUILDING VENT TO FRESH <br /> BE EOWPPES ABOVE COVER if MIII ELEV INU "S LINE 'p T'G�, a pIR WLET. <br /> / I 1 FEET FROM �L n J _.� <br /> NEAREST--w N sf- <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 /> meets the criteria for medium sand. TIONS MEASURED. <br /> L:1 YES 1:1 NO <br /> SOIL COVER TE.IURE PnmIFINl N1 MAHKI RI DBSf RvA TON WFELS <br /> _ L]VES FIND _❑YES ONO <br /> .11TH OVER THENCE' BED OEPTH'IVFH On N1:1171U UII'III 111 TIIP)IIII 11111UfH ]FIFIT 11 MULCHED <br /> CFNTER ED(IES <br /> ❑VES. ❑NO OYES ❑NO DYES ONO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> '.WIDTH LFNGTH NO.DF LATERAL SPACING ,,HAVE L DEPT H HE I UW PIPE WILL DEPTH ABOVE COVER <br /> BEDJYRENCHI TRENCHES <br /> DIMENSIONS!; <br /> MANIFOLD PUMP MANIF OL II DISTR PIPE MANIFOLD MAT FHIA, K DIRSTDISTR­PIPF MATERIAL&MARKING <br /> F ELEV. ELEV. DIA ELF V. PIPES DIA <br /> ELEVATION AND <br /> DISTRIBUTION HOLE SIZE HOLE SPACING CHILL FU CD1IHf(:I I.Y COVERMATEHIAL VERTICAL LIFT CORRESPONDS TOAPPROVED <br /> INFORMATION PLANS <br /> ❑VES <br /> ONO ❑YES ------E- <br /> NO <br /> COMMENTS: PERMANENT MARKERS. OB5ERVATION WELLS NUMBER OF. PROPERTY WELL BUILDING. <br /> FEET FROM-I <br /> ❑YES ❑NO ❑YES ❑NO _ NEAREST--- <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. TITLE <br /> 5'GN URE <br /> DILHR SBD 67101R.01/B2) <br />