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Jun. 2. 2009 8:54AM No. 0606 P. 2 . WiS,COnsin Department Ut Industry, ON SITE SEWAGE SYSTEM Safety&Buildings Division tailor and Human Relations INSPECTION REPORT P.O,Box 7969 . La¢ jr CJ'/r. ` '7.?17 rf Madison,WI'53707 County: NA/E.- 152tC 0 AT-GRADE 0 IN-GROUND PRESSURE ❑MOUND 0 HOLDING TANK El EXPERIMENTAL. J EW CI REPLACEMENT ❑RECONNECTION 0 OTHER(SPECIFY) Permit Holder's Name: Permit Holder's ddress; tnspettion Date: N.k6,/. C/(h ?j//J _ 6/2 7 oa-n sE7rG64fAN), MAzdln'tr•lie //'- -/- 93- Oench Mark,Describe ii Different From Plan: Parcel Tax I.D.AN), (Optional) Ref.Pt.ETev.: CST Ref-Pt.Elev.: •(L IN k'1— .5 j Pl4,/ _ _ bz. r ._o, t � 0 Plum•er•s Name: MP/MPRSW No- Assigned):State Plan ID No.(If Assi Sanitary Permit Number: S�7 Vim CieY ' Y.Yt .S- 6'-et - 0 /z ,v 27 4 S`? SEPTIC TANK/ . bAte— 0.3' M-an�acture /voter, Liquid p city: Tank/Inlet Elev.: Tank Outlet lev.: Warning Label Locking Coverr/,e� Bedding: C%+t$/nGt a/d /48K- 7 I6s`o cou..5- l4 Q y r0 Pro Xesd 0 NO Pr0lo Yes tt f J SY"o' 9 Est Dia.: Vent Mat'I.: High Water Alarm. NUMBER OF Road: Property line: "Well: Building: Air Vent: in-Yes ❑ No ((AO, flv FEET FROM _ ._ { ea;�-41� HEAREST� '_) -- DOSING CHAMBER: •— - Man u acturer: 8e j g Liqui• panty: PumpMeldel: Pump/Sip ion Menu a ret: High Water Alarm Warning Label Looting aver ❑ Yes a No Provided: Provided: QY- •No ❑Yes ONo ❑Yes ❑No Ga ons Per yc e; Pump an• o trolls Operational: NUMBER 7r.My Line: Wel: Building: Air Vent: (difference between FEET FROM own•on and off) ■ Yes • No NEAREST---1RA- Vent Insta e -741 Vent Malaria 7 FORCE Diame r; ,Material and Marking: VENT ❑ yes • MAIN SOIL ABSORPTION SYSTEM. Check the soil moist re at the dep.h of plowing or excavation. (If soil can be tolled i •a wire,construction shall cease until the soil is dry enough to continue,) DISTRIBUTION STSTEM: BEC/TRENCH Width: Lengtf): No,Trenches: Lateral Sp tiny: Cover Material: Inside Dia: No.Pits: -- Liquid Depth: DIMENSIONS / r( r s'yf1/4/ PIT _ Gravel ee ow Pipes Fiil Above Pipe: Inlet Elev.: Enc Elev.: Pipe Material• No.Distr.Pipes: NUMBER OF Property Line: well: j BwIarng: Air Vent: 6" ,,c, CrEd- 6.6LQ., /14_ FEET FROM F f NEAREST-} 2,i ELEVATION AND Manifold Elev.: Manifold Dia.: Mardi Id,'rla.teitiI; 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 No MOUND SYSTEM: Mound site plowed per ndicular to Ch- - e texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown lope mound systems to make certain that it ON REVER trsT5E. SHOW ❑ Yes ❑ No meet the criteria for medium sand. ELE IONS MEASURED. _ SOT CO VFR Texture; Permanent Markers; Otriervation Weill= - © Yes ❑r . O Yes ❑ NO Depth Over rent Bed Center: - epth ever Trench fled ••es: Depths opsod: Sod.- : See•ed: Mulcnea: • ■ Yes 0 No ❑ Yes ❑No 0 Yes E] NO COMMENTS:(Sketth System On Reverse Side) -.1/1417.4/LA •7/.4^/ ! -/Pc0 j/ 6)/< 7To e/qcgf/zz. LAPP' --rA Er(Ct/ —s- qv' ) ifig ` c bl i " '�" �l.Ar1// A M f/)611 7,�Er�CN �l6. ` 6. ` y v ` 1�6 r Le cr-hvviiv< / r „�, ✓�1 ' t b Fob 614x,% Lpf,✓V2 �c�lrcrf� 9s„z �15: 1 c42_! 1cPr 'raKez p6 7Arge 0m m.6 r /J -� n!o �uj.� v(� t✓�LL 7 J j •7�� 7% of 'nr,I . �rl1•C/e -,,y r � s�t�'rnt 7 qtr- y �f l q Psimr P A i s'/�,r.� l G f t►� rPGA�. A • 0 - 1-- A s/t, ( hbrnr--- • .5-61//4//q., -qv/I:v/4,y Signature: Title: (Keep a copy in your f de for audit) <Orl tl•nro nn MA%