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Thu/5. 11- 19-06( /o. v 0 <br /> PRIVATE ONSITE WASTE TREATMENT SYSTEMS Bumett County <br /> Visconsin ( POWTS) Property Address: <br /> Department of Commerce INSPECTION REPORT S<& S LV, <br /> Safety and Buildings Division (ATTACH TO PERMIT) <br /> Sanitary Permit No: <br /> GENERAL INFORMATION <br /> Personal information you provicic may be used for secondary s Ptivwv Law,s. 15.04(1 m)I <br /> Permit Holders Name: U CityJJ Village Town of: State Plan Transaction IDA: <br /> CST BM Elev: Insp BM Elev: BM Description: Parcel Tax No: <br /> /00.00 AIL 10 RQ OAIC V a�a-�aa3-cam <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Septic Benchmark UP 1p,2,�p q�,pD <br /> Dosing <br /> Aeration Bldg.Sewer <br /> Holding St/Ht Inlet 7, &4 95.oz . <br /> TANK SETBACK INFORMATION St/Ht Outlet •7,s5 <br /> TANK TO P/L WELL BLDG VENT To ROAD Dt Inlet <br /> AIR INTAKE <br /> Septic >75 Al/A �/{j' NA DtBottom <br /> Dosing NA Installation <br /> Contour <br /> Aeration NA Header/Man. <br /> Holding Dist Pipe 18.407 <br /> PUMP/SIPHON INFORMATION Infiltrative <br /> Surface 9.50 9 ./ <br /> Manufacturer Demand Final Grade 960, D <br /> Model Number GPM <br /> TDH Lift Friction Loss System Head TDH Ft <br /> Forcemain Length Dia I Dist To Well <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width (P Length 7Z No of Cells Type of System Manufacturer: <br /> SETBACK P/L Bldg wen, oHwM a Nav � LEACHING <br /> A <br /> INFORMATION g waters CHAMBER ln-9vctW��Q Model Number. <br /> CELL TO 7 57 /A <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes <br /> Length Dia Length Dia_ Spec Spacing ❑Yes ❑No <br /> SOIL COVER <br /> Depth Over Depth Over Depth of Seeded/Sodded Mulched <br /> Cell Center I Cell Edges Topsoil ❑Yes ❑No ❑Yes ❑No <br /> COMMENTS: (Include code discrepancies,persons present,etc.) <br /> Permit Posted? �v <br /> Schedule 40 Vents and Observation Pipes N <br /> Cover Material: 7-WAR <br /> Effluent Filter Manufacturer .2rA86t_ Model A-(eon <br /> Components Not Inspected: <br /> Plan revision required?❑Yes❑No <br /> Use other side for additional information Date Pldvrspectoes Sign Cert No <br />