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Wisconsin Department Of Industry, ON-SITE SEWAGE SYSTEM Safety&Buildings Division <br /> tabor and Human Relations Office of Division Codes&Applications <br /> Bo?(7969 INSPECTQN REPORT <br /> Ma , <br /> Madi son,WI 53707 4 geret. 6-z County: .C_ <br /> .12dONVENTIONAL ❑ ALTERNATIVE ❑ HOLDING TANK ❑ IN-GROUND PRESSURE ❑ MOUND <br /> Permit Holdgr' Name: Permit Holder's Address: Inspection Date: <br /> 71Q% 6/6 "4 S.. /, / G(/ , 9'" 24 - 93 _ <br /> Ben Mark(Permanent re eren a poi Ref.Pt.Elev.: CST Ref.Pt.Elev.: <br /> . 22..4.5-. 44e'er /00 a CO /OC),Cr)d 11 Plu bet's Na MP/MPR94H'No.: State Plan ID No,(If Assigned): Sanitary.Permit Number: <br /> '7i 72.: /9/ z,3 <br /> SEPTIC TANK 493 - Q3 7/ <br /> Manu acturer: Liquid Capacity: Tank Inlet Elev.: Tank Outlet Elev.: Warning Label Locking Cover <br /> ro ed: Provided <br /> /000 � ,48 ��� 3 Yes ❑ No ❑ Yes 'No <br /> Be ding: Vent Dia.: Vent Mat'L: High Water Alarm: NUMBER OF Road: Property Line: Well: Building: Air Vent: <br /> �� <br /> Yes ❑ No C 0 Yes FEET FROM o NEAREST—► /U, 4 r %.P5 >S' / Al,,¢ , <br /> DOSING CHAMilER: <br /> nufadurer: Bedding: Liquid Capacity: Pump Model: Pum /SisakiaMan facturer: Warning Label Locking Cover <br /> / P`r:4ced: I Provided: <br /> Yes ❑ No (,� s ❑ No 1 ❑ Yes ❑ No <br /> Gallons Per Cydfe. Pump ahRontrols Operatio : NUMBER Property Line: Well:/ Air Vent: <br /> (difference between 7 <br /> pump on and offs ��� 'Ayes ❑ No NEAREST-'*_ z <br /> >2'6", 75 >/O <br /> SAIL ABSORPTION SYSTE Check the soil moisture at the depth of FORCE Length: Diameter: Material an Markin <br /> p owln or exc* bo r) ,(I soi can be rolled Into a wire,construction / i� / <br /> Shall cease until tie s�if is ry enough to continue.) MAIN 3 ?- SK�J�C.L+�' 'dove <br /> DISTRIBUTION SYSTEM: <br /> IMO/TRENCH . Widt�: Length: No.Trenches: Lateral Spac5ing: Cov Material: Inside Dia: No.Pits: Liquid Depth: <br /> DIMENSIONS . 7s / '2 // / 7,,,,, PIT <br /> Gravel Below Pipes Fill A ove Pipe: Inlet Elev.: En Elev.: Pipe Material: r1o.Distr.Pipes: NUMBER OF 'Property- <br /> ro ert Line: Well: Buildin : Air <br /> p es: FEET FROM p y / 9 V n <br /> e t. <br /> 67^. -O /z4,8 9e,40 2 NEAREST-* ›'s i> ' <br /> S O >0 1ar-.. <br /> Manifold Elev.: Pump E ev.: Manifold Dia.: Manifold Material: No.Distr.Pipes: -Distr.Pipe Dia.: <br /> ELEVATION AND <br /> DISTRIBUTION Hole Size: Hole Spacing: Drilled Correctly: Permanent Markers: Observation Wells: Vertical Lift Corresponds To <br /> INFORMATION Approved Plans: <br /> ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <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 /> SOIL COVER I Texture: Permanent Markers: Observation Wells: <br /> ❑ Yes 0 N ❑ Yes 0 N <br /> Depth Over Trench Bed Center: Depth Over Trench Bed Edges: Depths Of Topsoil: Sodded: Seeded: Mulched: <br /> ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> COMMENTS:(Sketch System On Reverse Side) • <br /> c/ ;:D ,40''`-C.-13*/-te-e-- <br /> _) . „1,4-4". 1/t'All‘ <br /> • <br /> L .• <br /> Signature: Title: <br /> D•6710(R 01/90) (Keep a copy in your file for audit) <br />