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DEPARTM ENT OF IN DUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING <br /> LABOR&HUMAN RELATIONS DIVISION <br /> P,O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION <br /> MADISON.WI 53707 <br /> Barreltan I.D.Number. <br /> EJ CONVENTIONAL E-1ALTERATIVE <br /> ufessigoeal <br /> ❑ Holding Tank >11�1 In-Ground Pressure ❑ Mound <br /> NA E FPERMIT HOLDER. ADDRESS OF PERMIT HOLDERINSPECTION PATE'. <br /> eAL�. - �-6o tvdu f7a -, PWSs <br /> E H MARK(Permanent reference point)/DESCRIBE IF DIFFERENTFROM PLAN. REF.PT. LEV.. CST REF.PT ELEV.' <br /> III /I ec7ric /aWS7"19>"_ <br /> Name of Plumbe MP/MPRSWNo.: County: Sanitary Permit Number. <br /> tjtrKS '0I Surhe <br /> SEPTIC TANK/HOLDING TANK: <br /> MANUFAC rU ELAf LIGUID CAPACITY: TANKI LETELEV.. TANK UTLETELEV.: WARNINGLABEL LOCKI NG COVER <br /> �r�� PROVIDED_ PROVIDED'. <br /> ..3 YES ❑NO ❑YES NO <br /> BEDDING. VENT DIA VENT MAT L-. HIGH WATER NUMBER O ROAD' PROPERT WELL: BUILDING' VENTTO FRESH <br /> [� l( / L ALARM. FEET FROM / LINE' AIR INLET. <br /> ❑YES NO / [--]YES X1 NO NEAREST---- <br /> DOSING <br /> EAREST DOSING CHAMBER: <br /> MANU AC/.T}}�++/�f/.�R� BEDDING: LIQUID CAPACITY. PUMSP-lMO/DEAL'. PUMP/SIPHONM/ry/�UFACTURER WARNING LABEL LOCKING COVER <br /> f( l7(LL ❑YES NO _060 6600 .fJe ll'Pr PRoviDEo: PRovIDEo. <br /> AYES ❑NO DYES ❑NO <br /> GALLONS PER CYCLE: PUMPAND CONTROLS OPERATIONAL NUMBER4- <br /> SOIL <br /> ROPERTY WELL. BUILDING'. VENT TO FRESH <br /> (DIFFERENCE BETWEEN FEET FRNE (t�/ AIRINLET- / <br /> PUMP ON AND OFF YES ❑NO NEARES ---ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: METER: MATERIAL ANMARKINGorexcavation. (If soil can be rolled into a wire,construction shall cease until MAIN 7f <br /> the soil is dry enough to continue.) 77 <br /> /(J <br /> CONVENTIONAL SYSTEM: <br /> BED/TRENCH WIDTH. LENGTH. TRENC DISTR.PIPE SPADING' COVER INSIDE DIA.. (/PITS'. LIQUID <br /> TRENCHES: MATERIAL: PIT DEPTH <br /> DIMENSIONS <br /> GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL'. BUILDING'. VENT TO FRESH <br /> BELOW PIPES'. ABOVE DOVER. ELEV.INLET. ELEV.END'. PIPES FEET FROM LINE. AIR INLET: <br /> NEAREST—� <br /> MOUND SYSTEM: <br /> Mound site plowed perpendicular to 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 it ON REVERSE SIDE. SHOW <br /> ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. <br /> SOILCOVER I TEXTURE'. ANENT MARKERS: OBSERVATION WELLS. <br /> PERM <br /> E]YES ❑N =YES EI NO <br /> DEPTH OVER TRENCH/BED DEPTH OVER TRENCHIBED DEPTHS OF TOPSOIL SODDED. SEEDED MULCHED'. <br /> CENTER: EDGES'. <br /> I _❑YES ❑NO ❑YES ❑NO ❑YES ❑NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> BED/TRENCH WIDTH'. LENGTH NO OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER' <br /> DIMENSIONS <br /> /7' <br /> /a / TRE"GREs'. / / J( Q it <br /> MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATEPIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL 8 MARKING. <br /> ELEVATION AND E" EI 7 DCg2 JI ELE �v �vG PIPE oIA/� J( `� <br /> DISTRIBUTION t � O <br /> INFORMATION HOLE SIZE HOLE SPACING: DRILLED GORREC C COVER MAT RIAL VERTICAL LIETCORRESPONDS TO <br /> '/ �( APPROVED PLANS <br /> 'f f f o2 Jt YES ❑NO I7, �la`Y/�- YES ❑NO <br /> COMMENTS: PERMANENT MARKERS. OBSERVATI ON WELLS'. NUMBEROF PROP TY WELL'. BUILDING' <br /> AIYES ❑NO YES ONO FEET FROM LINE / <br /> �/ NEAREST—�� `/�J` / >/od <br /> 13 ed 01 <br /> �7.G3 C bra <br /> �N-nl�l�-7 i5 �'r��1Pf�AK �, lei � lorra5- <br /> lets <br /> COAL <br /> p <br /> r r�rem��s S , i f <br /> Sketch System�ij reIardl � Retain in county file for audit. <br /> Reverse Side. SIGNATURE: yt� TITLE <br /> SBD-6710(R 06/88) <br />