HomeMy WebLinkAbout020-1162-20-000 \ 0
2 �
k �
o �
b �
2 �
� J �
R �
R f �
� \ �
D
; m
z
• 6
� {
22
�
\ E
Z k k k
CL w
t
Q / k
�
0 § k C
k 7 S E
N (_D
)
7
_ & )
\ k } I
§ z w n
0 2
LL
ƒ CL f
> k =
LL q / k EL 3:
k 2 a a a IL
IL
- 0 C m c
2 j v k § § ƒ
> § § = 2
6 2 @
D " JfJ
� ■ 7
§ §
'm Co
\ o �
■ \ B < c
°
/ w 2
% ak � § ■ z
- ¢ \ § } j / o ) -!,OD k
a « E ) I
- 2 E e % f
. k k � ; k k
,PEPARTYENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 7969 BUREAU OF PLUMBING
MADISON WI 53707
NW,-, Sti,S23,T29N-R19W KXCONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number
assigned)
Town of Hu6on ❑Holding Tank El In-Ground Pressure ❑Mound )If a
Lot fax vattey kT, A- rIx
E bN'PPMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DAT
James 0. Daht 438 Jacobs Laney Hudtson, W1 54016 CI,,3v 7 2U
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: ICSTF111.PL ELEV..
Name of Plumber: MPfMPRSW No.: County: Sanitary Permit Number:
Richard Ha FiLnd 1059 St. Choi x 112682
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV_ WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
DYES ❑NO DYES ONO
BEDDING. VENT DIA.. VENT MATL.: HIGH WATER NUMBER F ROAD: PROPERTY WELL. BUIL DING. JVENTTOFRESH
ALARM FEET FRO LINE AIR INLET
❑YES ONO ❑YES FIND N
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED.
❑YES ❑NO ❑YES ONO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL I BUILOING7VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) OYES 1:1 NO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH'. LENGTH. NO.OF 1771ACING. COVER INSIDE.DIA SPITS LIQUID
BED/TRENCH TRENCHES MATERIAL PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH UISTR PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF IPRZ)PERTY WELL BUILDING V NT TOF HE$H
BELOW PIPES ABOVE COVER ELEV.INLET ELEV.END. PIPES FEET FROM INE. AIR INLET
NEAREST--
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
DYES ONO
SOIL COVER TE XTURE PERMANENT MARKERS OBSERVATION WE LLS
OYES ❑NO ❑YES NO
DEPTH OVER TRENCH/BED D BED EPTH OVER TRENCH/ DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES.
OYES 1:1 NO DYES ONO DYES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING (TRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE M NO DISTR fSTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKINI,
ELEV. ELEV,. DIA.. ELEV.. PIPES A
ELE VATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES ONO OYES ONO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING
FEET FROM LINE
❑YES El NO OYES ONO NEAREST
r
Sketch System on Retain in count (f4l f@haudit.
Reverse Side. L J
SIGNATURE TITLE.
DILHR SBD 6710(R.01/82) Zoning Admin.ti6tr"atan