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Wisconsin Department Of Industry, ON SITE SEWAGE SYSTEM Safety&Buildings Division <br /> Labor and Human Relations INSPECTION REPORT <br /> P.O.Box 7969 Lpr� Cs/,,‘ t�ZL <br /> Madison,WI 53707 County: DANE PAA?krC——4o <br /> CONVENTIONAL OAT-GRADE ❑IN-GROUND PRESSURE 0 MOUND ❑HOLDING TANK <br /> ❑ EXPERIMENTAL ❑NEW .121-REPLACEMENT ❑RECONNECTION <br /> 0 OTHER(SPECIFY)' <br /> Permit Holder's Name Permit Holder's Address: Inspection Date: <br /> R4Cc p l' 0t Art • ¢ eoGs K�.11e- Dn./t/6) s a �,eie 11—2 --fl <br /> Bench Mark,Describe If Different From Plan: Parcel Tax f.D.No.(Optional) Ref.Pt.Elev.: " CST Ref.Pt.Elev.: <br /> Ba'rloM OF S ID(/ ._ S-R r(a ' 21-4:"611-/02-s/�=6 /40.a 1 f� o <br /> Plumber's Name: MP/ PR W No.: State Plan ID No.(If Assigned): Sanitary Permit Number:, <br /> �0NN I�I! zZJs-gc Jq-. R'Q-6.5- !till.7c9 <br /> SEPTIC TANK/ <br /> Manufacturer: Liquid Capacity: Tank Inlet Elev.: - Tank Outlet Elev.: Warning LabeI locking Cover <br /> S7/4lC- IS -2'7 _� ro lied: Provided: Na <br /> Yes Q No ❑Yes gNo <br /> Bedding: Vent Dia.: Vent Mat'L: High Water Alarm: UMBER OF Road: Property Line: We I: Building: Air Vent: <br /> FEET FRM <br /> ❑*el 04I° _ NEAREST-10. S-71-- Sf S''` .S"---/-- <br /> ---.......„ <br /> DOSING CHAMBER: . - <br /> Manufacturer. Bedding: Lig pacity: Pump Model: PumprSip••n Menu urer:High Water Alarm War ' Label - Loc g Cover <br /> Yes ❑ N Provide Pr ided <br /> ❑Yes ❑No Q Yes o Yes Q No <br /> Gallons Per Cycle: Pump and Contro s Operational: '• BER Property Line: Well: Building. it Vent: <br /> (difference between FEE RpM <br /> pump on and off) ❑Yes fl No NEAR• T---► It <br /> Vent In ad: Ve iameter. Vent Material: FO• E Length: iameter•.- Material and Marki <br /> VENT es ❑No <br /> AIN <br /> SOIL ABSORPTION SYSTEM. Check the soil oisture at the depth of plowing or excavation. (If soil can be rolled into a wire,cons union shall cease until <br /> the soil is dry enough to continue.) <br /> �n� t <br /> DISTRIBUTION STSTEM: -C-At t{{T/Y G— Cii tetc,� e t 2'i(Fi e_7;e4-ira.< `5€ o- <5; <br /> BEDAvara Wi 'L`eength; No.Trenches: Lateral Spacing: Cover Material: Inside Dia: No.Pits: Liquid Depth: <br /> DIMENSIONS Idth: <br /> �f 6$3;7$ ---- PIT . <br /> — <br /> Gravel Below Pipes Fill Above Pipe: Inlet Elev.: En Elev.: Pipe Material: No.Distr.Pipes: NUMBER OF Property Line: Well: Building:- <br /> FEET FROM � Asir Vent: <br /> 3 <br /> .---5-Ft. __ — c7 AQ — NEAREST II -�Y ��( 07– <br /> ELEVATION AND Manifold Elev.: Manifold Dia.: anifold Material: No.Distr.Pipes: Distr.Pipe Dia.: <br /> DISTRIBUTION — - <br /> INFORMATION Ho•`le'Size Hole Spacing: Drilled correctly: Permanent M}rkers Observation Wells: Pump Elev.: Vertical Lift Corresponds To <br /> o _ Yes Q No Yes o <br /> MOUND SYSTEM: <br /> Mound site pl. ed perpendicular to Check the texture of the fill materia for P.• •E A DIAGRAM OF SYSTEM ' <br /> slope and furrows own unslope` mound systems to make certain that i •N REVERSE SIDE. SHOW <br /> ❑Yes 0 No meets the criteria for medium sand. ELEVATIONS MEASURED. <br /> SOIL COVER ( Texture: Permanent M. Observation Wells: <br /> • es 0 No ❑ Yes ❑ No <br /> •ept •verTrent Be. e• er: Dept • - rent -e• •ges: •ept s• Topsoi: o••e•: NI ee•e•: ulc e•: <br /> ❑ Yes ❑ No • Yes ❑No ❑ Yes ❑No <br /> COMMENTS:(Sketch System On Reverse Side) <br /> CT1.'4 P/' °K —cam/ 7 29.x( c>, <br /> G <br /> ---3+ PLoth e2 5N,r7,4446D /VCG✓ SEA' Zny oy12T <br /> Li <br /> Sw?cfl rc- <br /> 1641,17e I�Ljo T 6 ct. 7clf ( E7W 0Lp A /D may,/ 0. <br /> .„ PL Am B . 1/40 (F/er c rl Tory/,S(ZE •0F cX fS Tiirk -r -e'"?c r4-A4 , <br /> • <br /> 4,4, „.„., Az"/ c' ,4,1,,,,,-- .1&via2 sRn/1-74R1Anl <br /> TALLER Signature: Title: <br /> (Keen a coov in your flip In.aurt,r <br />