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1 <br /> Wisconsin Department Of Industry, ON SITE SEWAGE SYSTEM Safety&Buildings Division <br /> Labor and Human Relations INSPECTION REPORT _ o <br /> P.O.epic 7969 County: ��/� �-Erefi�� <br /> • Madison,WI 53707 <br /> &CONVENTIONAL ❑AT-GRADE ❑IN-GROUND PRESSURE ❑MOUND ❑HOLDING TANK <br /> ❑ EXPERIMENTAL ❑NEW f REPLACEMENT ❑RECONNECTION ❑OTHER(SPECIFY) <br /> Permit Holder's Name: Permit Holder's Address: // Inspection Date: <br /> � /20D 4 A(4 uf8 `6e46 *-accac� 2,24-, '&ic r� Asep(e�clj fr l 92- <br /> Bench Mark,Describe If Different From Plan: D Parcel Tax I.D.No.(Optional) Ref.Pt.Elev.: CST Ref.Pt.Elev.: <br /> r/A /2-4,7/2,..--10,7-9620 p f /R�0 <br /> 'T�� O�- Co„rckE7E �u�l�Cl� —-5.-12e h -( / <br /> Plumber's Name: MP/MPRSW No.: State Plan ID No.(If Assigned): Sanitary Permit Number: <br /> ARArocD Le s.:)"r ti 7•E 7 I'7 9W e 6 <br /> SEPTIC TANK/ -7,wK a((, TANK "L A� c /2—°_Sti'' <br /> Manufacturer: - Liquid Capacity: Tank Inlet EIev/ Tank Outlet Elev.: Warning Label Locking Cover <br /> ( q g 'VA Provided: Provided: �✓ <br /> -T� �f ZOaO r'O��gj Yes ❑ No ❑ Yes ,&j'No <br /> Bedding: Vent Dia.: Vent Mat'l.: High Water Alarm: NUMBER OF Road: Property Line: Well: Building: Air Vent: <br /> Yes ❑ No q 1`64 C.. ES <br /> � FEET FROM Zf`- 24-F ZS''` $/` <br /> DOSING CHAMBER: <br /> Manufacturer: Beddi •: Liq .Capacity: Pump Model: Pump/Siphon M ufacturer: igh Water Alarm War ' g Label Locking Cover <br /> Provi Provided: <br /> ❑ Yes o No ❑Yes ❑No ❑Yes N ❑Yes ❑No <br /> Gallons Per Cycle: Pump and Contro s Operational: NUMB Property Line:, Well: d Bull : Air Vent: <br /> (difference between FEET F <br /> pump on and off) Yes 1:1 No NEAR T <br /> Vent Installed: Vent 9 -meter: Vent Material: FORCE Len iameter: Material an M ing. <br /> VENT ❑ Yes ❑ • MAIN <br /> SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing or excavation. (If soil can be lled into a wire,construction shall cease until <br /> the soil is dry enough to continue.) <br /> DISTRIBUTION STSTEM: <br /> OED/TRENCH Width: Length: No.Trenches: Lateral Spacing: Cover Material: Inside Dia: No.Pits: Liquid Depth: <br /> DIMENSIONS S( 8" 3 /( srpiT 7`ti PIT ., <br /> Gravel Below Pipes Fill Above Pipe: Inlet Elev.: En Elev.: Pippe Material: No.Distr.Pipes: NUMBER OF Property Line: Well: Building: Air Vent: <br /> kJ7►- FEET FROM '4 4- 4- 24-r- <br /> id a 4{L" tee /g2oo✓ 2r72c1 3 NEARESTM■ ZS .Z S_ <br /> Manifold E v.: Mani Id Dia.: Manifold Material: No.Di .Pipes: Distr.Pipe Dia.: <br /> ELEVATION AND <br /> DISTRIBUTION <br /> INFORMATION Hole Size: Hole ing: Drilled Correctly: Permanent Markers Observation Is: Pump Elev.: Vertical Lift Corresponds To <br /> Approved Plans: <br /> ❑ Yes .0 No ❑ Yes ❑ No ❑ Yes No ❑ Yes ❑ No <br /> MOUND SYSTEM: <br /> Mound site plowed perpen.-cular to Check the texture of the fill material for PR• IDE A DIAGRAM OF SYSTEM <br /> slope and furrows thrown uns ..e mound systems to make certain that it • REVERSE SIDE. SHOW <br /> ❑ Yes ❑ No meets the criteria for medium sand. , ELEVATIONS MEASURED. <br /> Texture: - Permanent Markers: Observation Wells: <br /> SOIL COVER I ❑ Yes ❑ ■ . • ❑ Yes ❑ No <br /> Depth Over Trench Bed Center: 0•.•h Over Tren".Bed Edges: Depths Of Topsoil: Sodde• 't,ee ed: Mulched: <br /> • es ❑ No ❑ es ❑ No ❑ Yes ❑ No <br /> COMMENTS:(Sketch System On Reverse Side) <br /> I STALL41 o,' Aeek2*6L) — d)K 10 84f iL <br /> 1) .a ectf2_ sY Ec • <br /> "('2c ,( `S • 3 r r <br /> e o <br /> f <br /> TF-64(a 2 g2' i' g!•9 t 79.9 ' <br /> 7RErrul-3 Sal.! ` 71.2' 77.‘ 1 <br /> i (-0r ..-1 _...... <br /> ql, I c < /4»445-- __5-4,«z1--, (,,,, <br /> /,($'t :Titl <br /> Signature: Title: <br /> a copy in your file for audit) <br /> SBD-6710(R.09/90) <br />