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PRIVATE ONSITE WASTE TREATMENT SYSTEMS Burnett County <br /> Visconsin ( POWTS) PmpertyAddr�s: <br /> Department of Commerce INSPECTION REPORT o a <br /> Sa"and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No: <br /> GENERAL INFORMATION20 <br /> Persons)information you provide ma be used secon Pri Law,s. 15.04(1 m <br /> Permit Holder's Name: City Village own d: State Plan Transaction IDM: <br /> DAV5 �OCsE2 t�USk -0 <br /> CST BM Elm: Imp BM EI BM Description: (TR"Fgk&D) Parcel Tax No: <br /> /00.00 1 15 /JAIL 114 RF-0 OAK az4t-5/32 of 400 <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY F STATION --B—S--F— HI FS ELEV <br /> Sept VA/ EP— 1000 qojllovi' .. Benchmark 1.95 /ol.95 /Ge 00 <br /> Dosing m /o., „ <br /> Aeration Bldg.Sewer 8.50 3. <br /> Holding St I Ht Inlet <br /> 9.Z)590 <br /> TANK SETBACK INFORMATION St I Ht Outlet 9.3 to 92.59 <br /> TANK TO I P/L WELL BLDG V1WDO ROAD Dt Inlet <br /> Septic >90 >/00' 9 ' _ NA Dt Bottom 13, (9pe 85 7 <br /> Installation <br /> Dosing > /o, NA Contour <br /> Aeration NA Header I Man. 3.45 28.47 <br /> Hdding Dist.Pipe <br /> PUMP 1 SIPHON INFORMATION Infiltrative <br /> Surface4,50 9Z 4,5 <br /> Manufacturer I 6� u� , Demand Final Grade <br /> Model Number SPO GPM <br /> MH Lift Friction Loss System Haad TDH Ft <br /> Forcemain ii Length a g 1 Dia 2-1 Dist To Well > / <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width 3 Length 50NoofCells 2 rTy7pe of System Manufacturer: <br /> SETBACK OHWMofNav +enEioMOOLEACHING 1/1 AL-rRA-rok <br /> INFORMATION PIL Bldg wbI waters 9ro�nd CHAMBER odelNumber.CELL TO > +5 30' r AV > SoA4fr UIcK It <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> Header!Manifold Distribution Pipe(s) X Hde Size X HOIe Observation Pipes <br /> Length--AL Dia _ Length_ Dia_ Spac Spacing WYes ❑No <br /> SOIL COVER <br /> Depth Over Depth Over Depth d Seeded!Sodded Mulched <br /> Cell Center Cell Ed es Topsoil ❑Yes ❑No ❑Yes ❑No <br /> COMMENTS: (include code discrepancies,persons present,etc.) <br /> Permit Posted? Y& N <br /> Schedule 40 Vents and Observation Pipes?o N <br /> Cover Material: N/A <br /> Effluent Filter Manufacturer .ZAB$L Model A-loo — 12, <br /> Components Not Inspected: <br /> Plan revision required?❑Yes❑No g '05 7 3 1 <br /> Use other side for additional information Date POWTS pector's Signature Cert No <br />