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DEPARTMENT OF INDUSTRY, I PECTION REPORT FOR SAFETY& BUILDINGS <br /> LABOR & HUMAN REL'A'TIONS PRIVATE SEWAGE SYSTEMS DIVISION <br /> P.O.BOX 7969 BUREAU OF PLUMBING <br /> MADISON,WI 53707 <br /> CONVENTIONAL ❑ALTERNATIVE Sane Plan 1.D.Number <br /> ElHolding Tank F-1In-GroundPressure El Mound III—X eel <br /> NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER INSPECTION DATE <br /> � teve DeLvi_ 7 / ti <br /> BENCH MARK IPermanem rele...re pmnU DESCRIBE IF CIF E NT FROM PLAN. REE.PT.ELEV.'. [STRIFE PT.ELEV. <br /> 111 '9 <br /> I <br /> C v 2r W 07-�'- '/4-, yr-. <br /> Name of Plmnber, Cou <br /> // e MPIMPRSW No.. nty. Sanitary PermNumber. <br /> Oj �Cr � 3 )5—%( � c..._v_"e ff -' <br /> SEPTIC TANK/HOLDING TANK: <br /> MANUFACTURER. LIOUIC CAPACIT TANK INLET E LE V.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER <br /> IDEDPROVIDED <br /> V YES� POVVES ❑NO ❑ ' <br /> ❑NO <br /> BEDDING ENTDIA. VENT MAIL. HIGH WATER NUMBER OF ROAD. PROPERTv WEL_La1 BUILOIN� (VENT To FRESH <br /> ALARM FEET FROM LINE V AIR I"LET. <br /> ! YES NO '7 ❑VES ❑NO NEARESTt2a <br /> DOSING CHAMBER: <br /> MANUFACTURER BEDCING LIQUID CAPAOTV P]iEVMP MOUEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER <br /> PROVIDED PROVIDED'. <br /> DYES ONO DYES ❑NO DYES ONO <br /> GALLONS PER CYCLE: PUMP AND CONTROLS OPEHATIONAL NUMBER OF PROPERTY WELL Bun DIN('. VENTTOFRESH <br /> (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET` <br /> PUMP ON AND OFF) OYES [:]NO NEAREST—� <br /> SOIL ABSORPTION SYSTEM.Check thesoil moistureat thedepth of plowing FORCE LENGTH DIAMErEH MATERIAL AND MARKING <br /> or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN <br /> the soil is dry enough to continue.) <br /> CONVENTIONAL SYSTEM: <br /> WIDTH LENGTH rvo.of mSEE PIPE SPgcING covEH INSmECIA OPITS LIOwF <br /> BF.DDIMENSIONS <br /> SF d / �� / THENCH Es �/ MATE IAL. � PIT DEPTH. <br /> DIMENSIONS <br /> GRAVEL DEPTH FILLDEPTH UISTR PIPE DISTR.PIPE DISTR.PIPE MATERIAL NO DISTR NUMBER OF PROPERTY WELL BW LDING. VENT TO FRESH <br /> BE LHw PIP/E,sk, AeovE corvER ELEV INCLTET ELEv END PIP` FEET FROM LIN `I/ AIR.((SLE <br /> 40 ,J NEAREST—s 2v �/ (L <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 /> 11 YES NO <br /> SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WFLIS <br /> 1:1 YES NO ❑YES NO <br /> DEPTH OVER TRENCH'BED DEPTH OVER IRICCH'BID DEPTH OF TOPSOIL SODDED SEEDED MULCHED <br /> DEPT-OVER IRINI.8 7CENTER EDGES <br /> ❑VES 1:1 NO OYES 1:1 NO El YES El NO <br /> PRESSURIZED DISTRIBUTION SYSTEM: <br /> BED/TRENCH WIDTH LENGTH TNO OF RENCHES. LATERALSPACING. GRAVEL DEPTH BELOWPIPF FILL DEPTH ABOVE COVER <br /> DfNaNSI£NJS <br /> MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR PIPE pI SrRIQUTION PIPE MATERIAL&MARKING <br /> ELEVATION AND ELEV ELEV. DIA ELEV. PIPES DIA <br /> DISTRIBUTION <br /> INFORMATfON HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED <br /> PLANS <br /> 1:1 YES ONO 1:1 YES NO <br /> COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS. NUMBEA OF PROPERTY WELL. BUILDING. <br /> FEET FROM LIrvE' <br /> ❑YES ❑NO <br /> [-]YES ❑l, NEAREST <br /> Sketch System on Retain in county file for audit. <br /> Reverse Side. <br /> SIG T E'. TITLE. <br /> 01 LHR SBD 6710 (R.01/82) G� <br />