Laserfiche WebLink
14 <br /> PRIVATE ONSITE WASTE TREATMENT SYSTEMS County <br /> Vftconsin ( PoWTS) <br /> Department of Commerce INSPECTION REPORT <br /> Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No: <br /> GENERAL INFORMATION <br /> Persons!inforniationyou provide nily be used for secondary scs[Privacy Law,s.15.04(1)(m)I _D;P 6t 1. <br /> Permit Her s Name: State Plan Transaction IDN: <br /> nPI Aaac-' I 0 City )CEI's Wage Town of. ra <br /> - <br /> CST BM Elev. lnsO BM Eley: =Dcription: Parcel Tax No. <br /> I bql(.424 &-4400( —403 <br /> lam� r— �k'. — LO —qs as—ol <br /> TANK INFORMATION ELEVATION DATA)f I(paSte. <br /> TYPE MANUFACTURER CAPACITY STATION BS Hl FS ELEV <br /> Septic 777�7 QQQ Benchmark <br /> Dosing <br /> Aeration Bldg.Sewer -7, 2 %-96- <br /> Holding St/Ht Inlet 9.3a %,:35 <br /> TANK SETBACK INFORMATION VIEWO St/Ht Outlet <br /> TANK TO P/L WELL I BLDG AIR wTAKE ROAD Dt Inlet <br /> Septic >50, >ds' 1I > /Of NA Dt Bottom <br /> Dosing NA Installation <br /> Contour <br /> Aeration NA Header/Man. 8 a5 qq <br /> Holding Dist Pipe <br /> PUMP I SIPHON INFORMATION Infiltrative <br /> Surface <br /> Manufacturer -Z0eAe*- Demand Final Grade q oq� ILI,fq <br /> Model Number q8 GPM <br /> TDH"Lift Friction Lossa,& System Head TDHq,qjFt <br /> Forcemain Lengths$' 1 DiaA'' .Dist To Well > 5d <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width (0/ Length 0 NO OF Cells <br /> C'L, Type of System Manufacturer. <br /> SETBACK OHWM of No Collv'lbek LEACHING <br /> INFORMATION PIL Bldg well waters CHAMBER Model Number. <br /> CELL TO .2!.-50/ IAV >701- <br /> DISTRIBUTION STEM X Pressure Systems Only <br /> Distribution Pipe(s) X Hole Sze X Hole Observation Pipes <br /> Length Dia Length^ Dia Spec Spacing OYes C3No <br /> SOIL COVER <br /> --- <br /> Depth Over DeVth Over Depth of Seeded Sodded Mulched <br /> Cell Center Cell Edges Topsoil 0 Yes 0 13 Yes 13 No <br /> COMMENTS: (include code discrepancies,persons present,etc.) <br /> Components Not Inspected <br /> Permit Posted Cover Material 4?ocK cjo4i <br /> Warning labels on manhole covers w/locks <br /> Schedule 40 Vent Material <br /> Effluent Filter installed Model CC MFR. <br /> Plan revision required?13 Yes 40 <br /> Use other side for additional inforrriation Date POWTS Inspector's Signature Cert No <br /> Bureau of Field Operations,PO Box 7302,Madison,All 53701-7302 SOD-6710 R 13101 <br />