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Wig, idri tSin Department Of industry, _ ON SITE SEWAGE SYSTEM <br /> Labbrd Human Relations <br /> Q.O':"ficoa969 INSPECTION REPORT Safety&Buildings Divisic <br /> Madison,WI 53707 County: ����! S <br /> tY= C4V\'� _ <br /> lit6NVENTIONAL 0 AT-GRADE 0 IN-GROUND PRESSURE <br /> 0 EXPERIMENTAL 0 N� 0 REPLACEMENT Q�tOUNO ❑HOLDING TANK <br /> ❑RECONNECTION Q OTHER(SPECIFY) <br /> Permit folders Name: <br /> Permit Holder's Address: Inspection oats <br /> .gyp <br /> girt. - (9-2S-0 <br /> Mick,Describe firth(' recent From Plan: - ' Parcel Tax 1.O.No.(Optional) Ref.Pt.Elev.: <br /> CST Ref.pElev.: <br /> Mumbo' Name: MP W - - /0 0 0 X <br /> State Plan ID No.Of Assigned): Sanitary Permit Number: <br /> . rh ketrzi 2:20/4s . r� <br /> SEPTICTANK/HOLDING TANK: - � f° <br /> Ma adorer. ' <br /> •tied Capacity_ •Tank Inlet Elev.: jrTaank Outlet Elev.:, Warring Label Locking Cover <br /> jiff* J- . J '�I Cam! Yes 0 No Pr► Yes 0 No <br /> Bedding: Vent Om.: Vent Mat.: Nigh Water Alarm: N MBER OF Road: Pr <br /> L 1 1 YC FEET FROMKy : Well: Bui • ng: Air Vent: <br /> ►:.Yes ❑No Jes ❑No NEAREST + S - <br /> a OSING CHAMBER: - - - �' S S �i %S <br /> •Manufactu er. Bed tng: . Diquid1 • PumpMooel: Pum r hom- � PS P adorer• Hgh Water Alatm Wat La Yes ❑No P • ed_ Pro de Cover <br /> Pro d <br /> Per • �.�c r �_ es ❑ Yes ❑No ! es <br /> (difference between /0-5 <br /> - P a Opera • ` NUMBER Property Ctne: Air Yen No <br /> twin.on and off) <br /> Yes R No N NEETFEARESERST <br /> — <br /> Vent Insta Vent Diameter: Vent Matena � 5 y/ S <br /> VENT Yes ❑No / 11 FORCE Lengt Diameter: Maters a •Ma mg: <br /> SOIL ABSORPTION SYSTEM. Check the " moisture at the p u-c_ i depth of plowing or excavation. (If sod can be roll into a wire cons <br /> the sod is dry enough to Conti tie. /'�tract on shalt cease until <br /> DISTRIBUTION STSTE . ' G �� � 117 .V��'` <br /> BE0fTRENCH Wu g No. <br /> Tr • <br /> Lateral pacing: Corer Material: <br /> inside <br /> Oia: Na Pits:_ Liquid Depth:7 v - ' s 5 n 4-hell.Sts Below P'.-• Above Pipe: Mkt Elev • Ekv Pipe Material No./ .P'• - NMROM Property Line: Well: I Air ventI { ! Z f I+ Pi % NEAREST-0.- $ <br /> /d <br /> ELEVATION AND Wad.old Elev.: Manifold Dia.: Manifold Maternal: <br /> No.Distr_Pipes: D Pipe Dear <br /> - <br /> INF0RMA'nou emote Size Hole Spacing: Dril ed Corr,. Permanent Mark Observatronl Welts Pump Elev.: Vertical Lift Corres <br /> /fj .. ponds To <br /> 66�7 ]Rf Yes ❑No ;�Yes ❑No Yes ❑Ho ��o Yes kQ No <br /> JIOUND SYSTEM: <br /> - <br /> Mound siteplowed perpendicular to Check the texture of the fill material for <br /> I slope and furrows thrown umslope mounds PROVIDE A DIAGRAM OF SYSTEM <br /> Y� 0 No ystems to make certain that it ON REVERSE SIDE. SNOW <br /> } meets the criteria for medium sand. ELEVATIONS MEASURED. <br /> >OitCOVER I Texture: - <br /> Permanent Markers: Observation Wells: <br /> `Mlh• tee i 7 <br /> es ❑No EYes ❑No <br /> /^� B •_/._enter. Depth • Trench Bed Edges: Depths O opsot• •.�►'!: S Mulched: <br /> 1 Grit + rZ "± /� rl <br /> 6 f- Q Yes 0 No ❑Yes •Er No 0 Yes No <br /> OMMENTS:(Sketch System On Reverse Side) <br /> � •drat..u..Ic ,bra-v- gi <br /> 0 i S a <br /> 0 -C-- 11 03 .5 = /0z.1 /0- . <br /> 31 6S to-r a, - <br /> L` t of 3 /U /S 4£ ti) <br /> R.,,,,-1"-r tams----e___ 8, 9‘7 ..-: c? -7, 8 . <br />