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7tw /a " 30 <br /> PRIVATE ONSITE WASTE TREATMENT SYSTEMS Burnett Coun <br /> Visconsin ( POWTS) Property Address: �qDq <br /> Department of Commerce INSPECTION REPORT sfalk, J21 ib <br /> Safety,and Buildings Division (ATTACH TO PERMIT) <br /> Sanitary Permit No: <br /> GENERAL INFORMATION <br /> Personal information you provide my be used for seoundary Privaey Law, <br /> Permit Holder's Name: U City village Town of: State Plan Transaction IDN: <br /> dimer to rp -� <br /> CST BM Elew Insp BM Elev: BM Description: Parcel Tax Na. <br /> /00. ME 1IAIL ru I )ht6C OAK Z ` DIFF-9o�,0 0/ Sao <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Septic AA W / OO t/o, Benchmark - h 70 910.30 A00,Q7 <br /> Dosing Gvrnb,yc-E&-6& 7 0 /6" <br /> Aeration Bldg.Sewer&3,,' <br /> Holding St I Ht Inlet <br /> TANK SETBACK INFORMATION St/Ht Outlet le -!E-!Ee 78 7 <br /> TANK TO PIL WELL BLDG II TO ROAD Dt Inlet <br /> AIR INTAKE <br /> Septic >5' 1W >&.0' — NA Dt Bottom <br /> NA Installafion <br /> Dosing > zpo' Contour <br /> Aeration NA Header/Man. <br /> Holding Dist Pipe 9,�. <br /> PUMP I SIPHON INFORMATION grf�� °° 3 9/•SO <br /> Manufacturer 'zoEu-EfL. — Demand Final Grade <br /> Model Number /SZ SdpcYs GPM ST V* Cw. 16. ob <br /> TDH Lift 11.6 Friction Loss a$I System Head >T TDH,?3.4Ft PC Nji Rl bar, 4. 23 8.1,07 <br /> Forcemain Length I Dia I Dist To Well <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width Length No of Cells Type of System Manufacturer: <br /> SETBACK OHWMofNav GonuPn�onal LEACHING <br /> INFORMATION P/L Bldg Wei waters .711 ovno( CHAMBER Model Number: <br /> CELL TO > 5' 7 Sv > 5' ei'1 W Fr <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> Header I Manifold Distribution Pipe(s) a X Hole Size X Hole Observation Pipes <br /> Length_ Dia Length 76 Dia Spac _ Spacing �YYes ❑No <br /> SOIL COVER <br /> Depth Over Depth Over Depth of Seeded/Sodded Mulched <br /> Cell Center Cell Ed es =10 ❑Yes ❑No ❑Yes ❑No <br /> COMMENTS: (Indude code discrepancies,persons present,etc.) SysrSA( SE,LUES dK/Sr v&//ovm-, wlrcb is > 2oc l Awl+ <br /> Permit Posted? 0 N 816 SA uo b+f«, Fel- PR6s""T 140050 -* 66- A604+C6a 'A) <br /> mEAA- F)-ruae wlfM A 436w kAwsG AT A M-1744cr- OF X"' <br /> Schedule 40 Vents and Observation Pipes? ® N <br /> Cover Material: IYPAP- <br /> Effluent Filter Manufacturer R,orveE Model FTo 82Z <br /> Components Not Inspected: <br /> Plan revision required?❑Yes❑No 7 3 <br /> Use other side for additional information Date 1/� POWT Inspector's signt# Cert No <br />