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' - /-1/am, / �, : 0-0 <br /> Wisconsin Department Of Industry, ON SITE SEWAGE SYSTEM Safety&Buildings Division <br /> -Labor and Human.Relations INSPECTION REPORT <br /> P.O. Box 7969 <br /> M dison,WI 53707 County:: �lll tto <br /> CONVENTIONAL ❑AT-GRADE ❑IN-GROUND PRESSURE ❑MOUND ❑HOLDING TANK <br /> ❑ EXPERIMENTAL ❑ NEW ❑REPLACEMENT ❑RECONNECTION ❑OTHER(SPECIFY) <br /> Permit Holder's Name: Per it Holder's Address:') c '� Inspection Date: <br /> �nJ UJa I� f1, 5t�. p <br /> Bat eifiP, �d� us 171n.i c 7 %Z <br /> Bench Mark,Describe I Di Brent From Plan: Parcel Tax LD.No.(Optional) Rei_Pt.Elev.: CS Ref.Pt.Elev.: <br /> S' � 160 <br /> Plumber's Name: MP/MPRSW No.: State Plan ID No.(1 Assigned): Sanitary Permit Number: <br /> RU j III <br /> SEPTIC TANK/HOLDING TANK: <br /> Manufacturer: Liquid Capacity: Tank Inlet Elev.: Tank Outlet Elev.: Warning Label Lock ing Cover <br /> Sl /r L)�) qp /U C// ' / Pro Yesd Provided:�D No esNo <br /> Bedding: Vent Dia.: VentJM.at'l High Water Alarm: NUMBEROF Road: Property Line: Well:/ Building: Air Ve t: <br /> FEETFROM E] Yes Yes No lI r / LKd ❑ Yes No NEAREST-� /-SJ ' �S13 <br /> DOSIN C AMBER: <br /> Manufacturer: Bedding: Liquid Capacity: Pump Mo e : Pump/Siphon Manufacturer: Hig WaterAarm Warning Labe Locking Cover <br /> Provided: Provided: <br /> ❑ Yes ❑ No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No <br /> Gallo n s <br /> a ons Per Cyc e: Pump and Controls Operationa : NUMBER Property Line: We Building: Air Vent: <br /> (difference between FEET FROM <br /> pump on and off) I n Yes No NEAREST-* <br /> Vent Installed Vent Diameter: I Vent Material: FORCE Length: Diameter Materia an Mar ing: <br /> VENT ❑ yes ❑ No MAIN <br /> SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled into a wire,construction shall cease until <br /> the soil is dry enough to continue.) <br /> DISTRIBUTION STSTEM: <br /> BED/TRENCH Width: Lthe No.Trenches: Latera/l Spacing: Co�ver aterial: Inside Dia: No.Pits: Liquid Depth: <br /> DIMENSIONS 4, en / -, (O _ -J /y[L4d PIT �r,� ___T_.. 1_�_. <br /> Gravel Below Pipe Fill Above Pipe: Inlet Elev.: En Elev.: Pipe Material No.Distr.Pipes: NUMBER OF Property Line: Well, Buaai/lld/iingl; AirVee/nt <br /> it <br /> 8" /7 7'•av q •9� r� NEARE FEETFRo� 7 /40" , 7 7G TSI <br /> Manifold Elev.: Manifold Dia.: Manifold Material: No.Distr.Pipes: Distr.Pipe Dia.: <br /> ELEVATION AND u <br /> DISTRIBUTION lT J 37 <br /> INFORMATION Hole Size: Hole Spaung: Drilled Correctly: Permanent Markers Observation Wells: Pump Elev.: Vertical Lift Corresponds To <br /> Approved Plans: <br /> ❑ Yes ❑ No ❑ Yes ❑ No 1 ❑ Yes ❑ No ❑ Yes ❑ No <br /> MOUND SYSTEM: <br /> Mound site plowed perpendicularto Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM <br /> slope and furrows thrown unslope mound systems to make certain that i[ ON REVERSE SIDE. SHOW <br /> ❑ Yes ❑ No meets the criteria for medium Sand. ELEVATIONS MEASURED. <br /> Texture: Permanent Markers: Observation We s: <br /> ILC VER <br /> ❑ Yes ❑ No El Yes ❑ No <br /> Depth Over Trenc Be Center: Depth Over Trench Bed Edges: Depths Of Topsoil: Sodde See e . Muc e <br /> ❑ Yes ❑ No ❑ Yes ❑.No-_ ❑ Yes ❑ No <br /> COMMENTS:(Sketch System On Reverse Side) v <br /> 6 ,30 <br /> er <br /> -7 116 <br /> IJU r <br /> Lk <br /> as 1-0 �p{� <br /> U9� Signature: Title:(Keep a copy in your file for audit) <br /> SBD-6710(R.09/90) <br />