Laserfiche WebLink
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING <br /> LABOR&HUMAN RELATIONS - PRIVATE SEWAGE SYSTEMS DIVISIOl <br /> P.O.BOX 7969 BUREAU OF PLUMBiNI <br /> MADISON,Wl 53707 <br /> WCONVENTIONAL ❑ALTERNATIVE State Planl.D.Nurnber: <br /> I II a„Igned) <br /> ❑Holding Tank ❑ In-Ground Pressure ❑Mound <br /> NA E OF PERMIT HOLDER: ADDRESS Of PERM( NOLDER: IN DATE: <br /> aLe <br /> BENCH MARK(Permanent reference polntl DESCRIBEy IF DIFFERENT FROM PLAN: REF.PT.ELEV.: 7CST /F.PT.ELEV. <br /> Name of PI—be, MPIMPRSW No.. Cnumyyy;; Sanitary Permit Number <br /> SEPTIC TANK/ <br /> MANUFACTURER LIQUID CAPACITY TANK INLET ELEV.. TANK OUTLET ELEV, WARNING LABEL LOCKING COVER <br /> ` / PROVIDED: PROVIDED: <br /> //'-/rj :J u �- [AYES ❑NO DICED: <br /> ❑NO <br /> BEDDING: VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: 1p"44" <br /> OPERTY WELL BUILDING. VENT TO FRES <br /> It ALARM FEET FROM .r- LINE I / ! AIR INLET: <br /> DYES ONO ��� ❑YES ❑NO NEAREST -�G At f 12 <br /> DOSING CHAMBER: <br /> MANUFACTURER =�CD . LIQUID CAPACITY PIJMV MODEI PVMPi SIPHON MANUFACTURER WARNING LABEL LOCKING COVER <br /> PROVIDED' PROVIDED: <br /> S -]NO DYES LINO OYES ❑NO <br /> GALLONS PER CYCLE: PVMPAND CONTROLS OPERATIONAL. NUMBER OF PROPy- - <br /> WELL BUILDING VENT TO FRES <br /> (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET <br /> PUMP ON AND OFF) ❑YES ❑NO NEAREST <br /> SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAME TE RIAL AND MARKING. <br /> or 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 NO.Of DISTR PIPE SPACING COVER INSIDE DIA *PITS LIQUID <br /> BED/TRENCH ! TRENCHES MATERIAL: PIT DEPTH: <br /> DIMENSIONS I G o <br /> ,RAVEL DEPTH FILL DEPTH DISTR PIPF DISTR PIPE DISTR.PIPE MA RIAL: NO.DISTR. NV BER OF PROPERTY WELL BUILDING: VENT TO FRES <br /> BELOW PI ES ABOVE COVER FI FV.INLET ELEV.EN? PIPES LINE AIR INLET: <br /> �-° NEARESFEET T <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 /> OYES ONO <br /> SOIL COVER lTFXTQRF fFHMANFNT MARKERS. OBSERVATION WELLS <br /> OYES ❑NO DYES ONO <br /> DEPTH OVER TRENCHTT DEPTH OVER THENCH:BED Uf PTH Of TOPSOIL SODDED SEEDED MULCHED <br /> CENTER EDGES <br /> DYES LINO OYES ONO OYES ONO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> BED/TRENCH WIDTH JLFNGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER <br /> DIMENSIONS <br /> MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR DISTR PIP DISTRIBUTION PIPE MATERIAL&MARKING <br /> ELEV, ELEV OIA. ELEV.' PIPES CIA,: <br /> ELEVATION AND <br /> DISTRIBUTION INFORMATIONHOLE SIZE HOLESPACING DRILLED CORRECTLY COVER MATERIAL VER TI CAL LIFT CORRESPONDS TO APPROVED <br /> [:]YESPLAN S <br /> YES ONO DYES ❑NO <br /> COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BVILDING: <br /> FEET FROM LINE: <br /> ❑YES El NO El YES El NO NEAREST <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> SIGNATURE TITLE: <br /> DILHR SBD 6710(R.01/82) GC- �- <br />