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Wisconsin Department Of Industry, ON SITE SEWAGE SYSTEM Saf ty& ildings Division <br /> ',•labor and Human Relations INSPECTION REPORT <br /> P.O.Box 7969 TowdsHI P Ze <br /> , Madison,W1 53707 County: hA11(e Orz,.5 te, ; .z-toc_ <br /> •(--32rONVENTIONAt OAT-GRADE ❑IN-GROUND PRESSURE-❑MOUND ❑HOLDINWTANK <br /> ❑ EXPERIMENTAL 3P,JEW ❑REPLACEMENT ❑RECONNECTION ❑OTHER(SPECIFY) <br /> Pere'•er s Name: - Permit Holder's • •.ress: ,, Inspection Date: <br /> •4- t 2780 ' - £4--�,?4c //- /0—0,3 <br /> Bench Mark, Par;. ax I.D.No. Option Ref.Pt.Elev.: CST Re .Pt.Elev.: <br /> � ' . , „� G /Cab• 00 X00.oa <br /> M W� <br /> PIUPRGYO.: State Plan ID No.(I Assig •): Mary Permit Num. r: <br /> �"� "7/7 2— ¢3s-Z 8 L <br /> SEPTIC TAN v - - <br /> er: •• 6.6)e. <br /> Capacity' T Inlet Elev.: an •utlet .: War to• 1311c mg Cover <br /> B _tom Yes Q No Yes ❑No <br /> *Yes ❑No L,p.I Pic 'L:• High Water NEARS FROM S ....../ <br /> i-one: We Building: A+Vent: <br /> DOSING CHAMBER: <br /> �'la ifadTurer: ,Bedding: Liquid Capacity. Pump Model: PumpliphonManufacturer High Water Alarm Warning Label Locking Cover <br /> '�/����`�- .4 es 0 No • it 98 _•o . - Yes O No 'es ❑No Yes.{]No <br /> as : . . T!"r'. sr'. _ --T�;: R ... . .' •t', <br /> FEETFROM n^g enL. <br /> pump On and /`3/ fifes Q No' NMI”- ' 5 if: u'ff S r'f' (a!� <br /> Vent Installed: Vent Diameter: Vent/Matenal: FORCE •length: I Diameter:i Material and Marking: <br /> VENT �ItYes 0 No t/ Scl� P//G [MAIN 80 I z ~ 1 cc.. mrc <br /> SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing or excavation. (II soil can be rolled into a wire.construction shall cease until <br /> the soil is dry enough to continue.) <br /> DISTRIBUTION STSTEM: <br /> BED/TRENCH Width: Length: No.Trenches: Laterals ng: Cover Material: Inside Oia: No.Pits: Liquid Depth: <br /> DIMENSIONS (o' 84' 3 c7 J i PIT . <br /> ra - • . . P,. F• . •••. yPope: Pipe Materia No.Distr. <br /> 30 FEET FROM But P.'mg: Air Vent <br /> ►�' % • r G NEAREST-* s. /0 f' ZST4 <br /> ELEVATION AND Mani ••E .: rrF•► r• ° •s,Mate' : No.Distr.Pipes: Distr.Piper .. <br /> DISTRIBUTION • • <br /> WFORpAATION Hole Size. Hole Spacing: • •Corr e Permanent Mark Observation Wells Pump Elev. Vertical lift Corresponds To <br /> Yes- -116-t—Q.Yas-tom --r�e vet 8.1>I,..T_. <br /> 0 Yes 6-No <br /> MOUND SYSTEM: • <br /> • •site plowed .. • •icular to Check -texture oft ill material for PR r i4 A DIAGRAM OF STEM <br /> slope a ,•furrows own unslope mounds • - .to • e certain that it ON R RSE SIDE. 5 •W <br /> 0 Yes 1 o meets the Grit for medium sand. ELEVATI• S ME RED. <br /> SON COVER I Te Permanent Markers: O• ation Wells:' <br /> Depth Over7r- • Bed Cent r ❑Yes 0 No ^ t Yes 0 No <br /> Over Trench BedE•• Depths 0 •.• •l: sodded: Mulched: <br /> O Yes ❑No O Yes 0 No 0 Yes ONO <br /> COMMENTS:(Sketch System On Reverse Side) zit y7. /0...4--7 <br /> .,IcTALLA>oet Berle D— OK To .25"f?tK/'LL <br /> '/,vc s.-1- .s,'--Red 415,4...r . s <br /> sue , <br /> ' <br /> C-/ /0. 07 / 0o • 4-o /6.O 7 /0 so ..9-o /d.97 '1.so /lC l„SO <br /> G=, 7/. Z 7 9 9 • t.o //.?� 7 fy. o ' /2./7 58.30 <br /> _ Le..3o) <br /> C /z-s-7 7 97 . r 0 /S.S7 97, 7 0 /3,47 97.00 (?_7•oC-)) <br /> • <br /> PV dTAL 40 Pr si6„rA 1 R6 d7 7a- - SEtwa,C J,4rv1 TA<l*1 <br /> Signatur In/SPEcTp7Q Title: <br /> SBD-67101R 09/401 (Keep a copy in your file for audit) <br />