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<br /> DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
<br /> ',LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
<br /> P.O.BOX 7969 BUREAU OF PLUMBING
<br /> MADISON,WI 53707
<br /> , F,∎iy,.,,q- ' ❑CONVENTIONAL .ALTERNA.TIVE Stat•Plan I.D,Number:
<br /> ❑Holding Tank El In-Ground Pressure SMound (HasFillnetl)
<br /> 83—etYSzi
<br /> NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
<br /> 4 ' 'A1-.S10 t11/4) �4617 Our 140tart•frrt e(-t 5z.?).• 30
<br /> BENCH MARK(Permanent reference pomtl DESCRIBE IF DIFFERENT FROM PLAN REF.PT.ELEV.. CST REF.PT.ELEV
<br /> of Plumber. PRSW No. county. SmMery Permit Num
<br /> da l nt�loc.Z `y($ 476Ze 7eI--o 19 4,
<br /> SEPTIC TANK/HOLDING TANK:
<br /> MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER
<br /> A
<br /> PROVIDED PROVIDED.
<br /> l 6 OYES ❑NO OYES gh10
<br /> BEDDING VENT DIA VENT MAIL HIGH WATER .I "'ROAD: PROPERTY WELL BUILDING.VENT TO FRESH
<br /> E,y Q7Q�,/��_/_'1 ALARM ,vt 1 =' 4:e LINE t AIR INLET
<br /> YSIYES ❑NO C"�• OYES )EINO >°, ��� 7'SU � 11 -�
<br /> DOSING CHAMBER:
<br /> MANUFACTURER BEDDINI'a:�..�i., LIQUID CAPACITY PUMP MODEL PUMP;SIPHON MANUI AC TUNER WARNING LABEL LOCKING COVER
<br /> &Y ES ��' y.�
<br /> PROVIDED: PROVIDED:
<br /> e�yrES 0 N `^"^-› 3" S►ii'Ft'�) eNv BYES 0 N 2LYES ONO
<br /> GALLONS PER CYCLE: PUMP AND CONTROLSOPERATI L 1 RT ..•Za ..,:PROPERTY WELL BUILDING VENT TO FRESH
<br /> (DIFFERENCE BETWEEN IZ�4- l.. I LINE,pz �.—� �� AIR INLET.
<br /> PUMP ON AND OFF) f ❑ S O3 e tiO
<br /> SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing 774,,,,:,I E NGTII OIAME TED MATERIAL AND MARKING
<br /> or excavation. (If soil can be rolled into a wire,construction shall cease until k ` u
<br /> the soil is dry enough to continue.) X ,° try ZN ��
<br /> CONVENTIONAL SYSTEM:
<br /> x p , Y t: LENGTH NO OF DISTH PIPE SPAC INC, COVER - - 'INSIDE DIA SPITS LIQUID
<br /> ` ; ° a TRENCHES MATERIAL' E DEPTH
<br /> 1,-•V L DEzP FILL DEPTH U13TH PIPE IDISTR PIPE 'DISTR.PIPE MATERIAL NO DISTR > 'f .PROPERTY 'WELL BUILDING. VENT TO FRESH
<br /> BELOW PIPES ABOVE COVER El.EV INLE I(ELEV END I PIPES ' r -'I LINE AIR INLET
<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 /> A4'cleq.---- 2:1 'fin-C'E meets the criteria for medium sand. TIONS MEASURED.
<br /> jiiirYES ONO
<br /> SOIL COVER'TEXTURE PERMANINTMAHKEHS OBSERVATION WE LLS
<br /> ` l. 'YES 0 N ZYES ONO
<br /> DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL SEII)DEI) SEEDED MULCHED
<br /> CENTER ��, EDGES L'z" 1 ---4-It OYES. 'ENO ,. YES • ❑NO EVES ONO ,
<br /> PRESSURIZED DISTRIBUTION SYSTEM:
<br /> gym- .:y:' WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE ILL DEPTH ABOVE COVER
<br /> ,401. �� TRENCHES. } ���, •/...
<br /> (Z — i 8 ".
<br /> y e / (O
<br /> MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO UISTH DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING
<br /> ,_� ELE V.: ELEV. DIA. t ELEV. PIPES DIA: t
<br /> ; , q tbr,•6S"" Ill.$$ I %z." 1 CO E • IC•44l°Py�L Z I 'a SA4 GCo WC--
<br /> . if a HOLE SIZE w HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROV , [
<br /> �6 4 PLANS IL•
<br /> DYES ❑NO �fL+�� YES { ❑NO
<br /> COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS a - 1 T PROPERTY WELL: BUILDING:
<br /> II YES ONO N'YES ONO t. 4 r':-- .„-..i ,,. , >10 T Ice. ,'lOp
<br /> c illt6o.s A+Pa w Z9 " c7-1 , ?C,`'t A-eot.ye>
<br /> K-Etv M6cei___ s -c6--2.G. 0. S •T,
<br /> (a•■,pil Mol"S z_ P Zs--s13
<br /> i-R f Me:4"i 44est,..z_RAE ZS-39
<br /> Sketch System on _ ,I Retain in county file for audit.
<br /> Reverse Side.
<br /> SIGNA '/'r/ TITLES,,�.,�)
<br /> DlLHRSBD6710(R.01/82) -/41. g �404�' /�01[� a"[`raitar �
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