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Wisconsin,l?epartment Of Industry, ON SITE'SEWA E SYSTEM Safety&Buildings Division . .' abor'and Human Relations INSPECTION REPORT �Gl�r s-cf�pp_ - " :,.O.Box 796'9 T�� S'U�! LOT Madisoh,WI 53707 County: ', € R --(0 ONVENTIONAL OAT-GRADE ❑IN-GROUND PRESSURE ❑MOUND 0 HOLDING TANK ❑ XPERIMENTAL 0 NEW yi REPLACEMENT ❑RECONNECTION ❑OTHER(SPECIFY) . Permit Nplder's Name: Permit Hold-is Address: Inspection Date: x t r KA 0 3740 al-4 -1 Oh 1>l, /1l' l 7-/.s ' -.6-q Bent Mar ,Descn•el Di'erentFromPlan: Parce Tax I.D.No.(Optional) Re .Pt.Elev.• CST•e .Pt.E ev.: i rak∎ o F (-(.oust S/Di i Se.e '�c1 i, o7- )-0--�.s,/zsv s=n /00.0' 10 0.0/ Plumber's Name: MPIMPRSW No.: Stele Plan ID No.(If Assigned): Sanitary Permit Number: frEVr 1Ef$1E. 336.6 b4' q 5I-0373 d Z/6 2-92 SEPTIC TANK/HOLDING TANK: Manufacturer: Liquid Capacity: Tank Inlet Elev.: Tank Outlet Elev: Warning Label Locking Cover 67u5t(,t(` l /h emu` Soo 1Zro +$on 416.9 q t 46.7 V ( Provided: Provided: --NUMBER ❑ Yes ❑ No ❑ Yes ❑ No Bedding: `!Ga tDia.: Oat Mat'I.: High Water Alarm: OF Road: Property Line: Well: Building: Air Vent: Yes ❑ No .Q N I�� FEET FROM ,� ......----• NEAREST--0. /rJ /'Ot Z ..4-4- _ OSING CHAMBER: Manufact er: Bedding: Liquid city: Pump Model: Pu iphon Manufactur-r: High Water Alarm ' Warning Label Locking Cover .vided: Pr ded: ❑Yes ❑ ❑yes ❑No • es ❑No es ❑No Gallons Per Cycle: Pump and-Contro s Operatio :- BER ' Property Line: Well: .'din.• Air Vent: (difference between . EET FROM pump on and off ❑ Yes ❑No AREST—► nt Installed: Diameter: Vent Material: ;.CE Len. : - Diameter: Material an ,:rking: VENT ❑ Yes ❑ No MAIN SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled int. ire,construction sh II cease until the soil is dry enough to continue.) DISTRIBUTION STSTEM: BED/} Width Length: No.Trenches: Lateral acing: Cover Material: RtN H Inside Dia: No.Pits: Liquid Depth: DIMENSIONS 2.2- g6 6 •.C.y / PIT , Gravel Below Pipes Fill Above Pipe: Inlet Elevf: En Elev. Pi Material: No.Distr.Pipes: NUMBER OF Property Line: Well: Building: Air Vent: f✓i Mrs/ 39-36 qS,7,z qS.Jy vv c,,_ '71 FEET FROM NEAREST- . -s ( ZS/ ZS'e ELEVATION AND Manifold Elev.: Manifold Dia.: Manifold Material: No.Distr.Pipes: Distr.Pipe Dia.: DISTRIBUTION - -...____-____ _ INFORMATION Hole Size: Hole Spacing: Drilled Correctly: Permanent Markers Observation Wells: Pump Elev.: Vertical Lift Corresponds To Approved Plans: MOUND SYSTEM: ❑Ycs 0 N Mound site plowed perp dicular to Check ure of the fill material for PROVIDE A DIA •M OF SYSTEM • slope and furrows thrown u pe and systems to make certain that it ON REVERS DE. SHOW ❑ Yes ❑ No meets the criteria for medium sand. EVA •NS MEASURED. SOIL COVER I Texture: Permanent Markers: Observation Wells: ❑ Yes ❑ No NI Yes ❑ No Depth Over Trench Bed Center: Depth Over Trench Be es: - Depths Of opsoil: Sodded: See•ed: ched: ❑ Y- 0 N _ ❑ Yes 0 No 0 Ye 0 No COMMENTS:(Sketch System Reverse Side) 0 ©� w ��/L� -� C(N,LA , . M4 V� — to • y FLowud6 of 6-j((i174 'lisple cx4,61 rr fEP'T!c -z' = 4 7 `f`f. "� P4UhtBE2 / Pub p/ Idoec-TED e 4ple'Ro f,ED ez IS 7?44. i&P7c 744e. ---*00161) #Z A4602.t6&TE M MAD thgv• fA,fD 1r 6-7eA/iK *le: atD DRk IReLD CA'i4o7 BF it A y.'P i_f s-TATE VA,o' rc 4e6 O14"TA eP F.,t- SerniC. T4i ( SIZE /j4) Hog c6- 70 IRA(NFtet0 f - f r --_). 193--2 Re 1-..,r &-1 a'v As Fee- if �E Fq< /2E7,4R4r .Ty1�Fc7iov; ....iiiiidA.D.111-e-c) , /rn�S7 Ir..a.A.� C r► ' V-4117�/2/A4i '�"''"'/` Signature: • Title: (Keep a copy in your file for audit) SBD-6710(R 09/90)