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DEPARTMENT OF INDUSTRY, INSPECTION REPORT EPOR SAFETY& BUILDINGS <br /> LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION <br /> P.O. BOX 7969 BUREAU OF PLUMBING <br /> MADISON,WI 53707 <br /> ACONVENTIONAL El ALTERNATIVE State Plan IDN„mee. <br /> Ill ass�Bn�l <br /> ❑Holding Tank ❑ In-Ground Pressure ❑Mound <br /> NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER'. I INSPECTION DATE. <br /> '4 3&Z <br /> BENCHMARK W—anen.r1 erInYF OmmI DESCRIBE IF DIFFERENT FROM PLAN REF.PL ELEV.'. CST REF.IT ELEV <br /> NIm n uI ml MRWP.BSY4 Nn Cou Sennery Parmn Number <br /> o✓ /l�bn -ems 336 <br /> SEPTIC TAN K/H G TANK: <br /> MANUFACTURER LIOUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV WARNING LABEL LOCKING COVER <br /> a T11 � 1 O PR�OiV ICED. PROVIDED <br /> i4all <br /> _6( 20 yFIYES NO VYES ONO <br /> BEDDING VFNT DIA VENT MATL 111611 WATER ROAD: PROPERTY WELL. BUIL 1 ENT TO FRESH <br /> ��,r ALARM //, LINEy J AIR INLET <br /> OYES 1 NO �elV [KVEs ❑No <br /> DOSING CHAMBER: <br /> MANUEACTUnFH BEDDING Ilnlllll('APA(.IIY PUMV Mf1DCL PUMP/SIPHON MANVrACTIIREH WARNING LABEL LOCKING COVER <br /> -7�'/L/ y / PROVIDED'. PRROOVIDED. <br /> P / ❑VES �NO �d1' W'l Qj/ t ISIYES ONO ZYES ONO <br /> GALLONS PER CYCLE I v�' J PUMP AND CONTROLS OPERATIONALa' PROPEHTv WILL tlVILDmr. VENT TO FRESH <br /> (DIFFERENCE BETWEEN 41 LINE AIR INLET <br /> PUMP ON AND OFF) Of VES <br /> ONO 2tu <br /> SOIL ABSORPTION SYSTEM.Check thesoilmoistureatthedepthof plowing $' appr*� LENr TOIAFTER MATIHIAL ANDMARKINr, <br /> or excavation. (If soil can he rolled into a wire,construction shall cease until ,r .WaH M <br /> + <br /> the soil is dry enough to continue.) ro <br /> ua <br /> CONVENTIONAL SYSTEM: <br /> $ j b WID"I I'DOTlyNO of CISR PIPL SPACING covlR . ^ - a wsmE DIn �vllI uDUIC <br /> �4� / /1 Yy)t TRENCHES MgiEHIA/L'�' DEPTH'. <br /> 7✓ W' <br /> L 1 1 VILE OkC") <br /> V'T 11 ISIR PIPE LIBOR LL DISTR.PIPE MATERIAL NO DISTR e R* PROPERTY WELL BUILDING VENT TO FRESH <br /> Hf10W PIv 5� ABovEGErvER L t1 NLl1 ELIV IND/ � PIPES ;j LIN � AIRINLET <br /> IF lip <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 REVERSE SIDE.SHOW ELEVA- <br /> meets the criteria for medium sand. TIONS MEASURED. <br /> EYES ❑NO <br /> SOILCOVER OxI,1111 PIHMANINT MAR KERS DBSFHVATION WE LLs <br /> DYES ONO ❑YES ONO <br /> DtmH uvnl nlf NIH HID nEPnI nvFH nIOYnI BFII uEPIH DI TOFsuIL snDDEu SEEDED MULCHFn <br /> (:I NIfH EOG FS <br /> ❑VES ❑NO ❑YES ❑NO OYES El IN <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> 2' y{ WIDTH IEN(,TII NO.OF I.A I F H A L S P ACI N G G H A V I L DE P T H B E L UW P I P L FILL DEPTH ABOVE CUVFR <br /> qb TRENCHESIF . <br /> vv MANIFDID PUMP MANIrOLD SISTER PIPE MANHOLE MATERIAL NODISTH DISTR PIPE DISTHIBUTIONPIPE MATFHIAL&MARKING <br /> '�� g#'.�.I, ELEV. ELIV CIA ILEV PIPEI DIA. <br /> "h HOLE SItF HOLE SPACINI. OHILI ED COHRECILY COVER MATENIAL FLAGS LLIIi COHNESPONDS TO APPRDVtO <br /> � $ PLANS <br /> 4v86,s,1- <br /> . EYES ENO ❑VES ONO <br /> # <br /> COMMENTS] PERMANENT MARKERS. OBSERVATION WELLS %4 BE <br /> WELL BUILDING <br /> & LINE <br /> DYES ❑NO DYES ❑NO _ <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> ]TITLE <br /> DI LHR SBD 6710 (R.01/82) <br />