Laserfiche WebLink
\LtI • PRIVATE ONSITE WASTE TREATMENT SYSTEMS Burnett County <br /> isconsin ( POWTS) Property Address: <br /> Department of-Commerce INSPECTION REPORT //�`0 Pct. <br /> Safety and Buildings Division (ATTACH TO PERMIT) ti 30 Sanitary Permit No: <br /> GENERAL INFORMATION i j1� "�" 1(1 '26�U 7 (� <br /> Personal information you provide may be used for secondary purposes[Privacy Law,s. 15.04(1Xm)] � /0 <br /> Permit Holder's Name: 0 City 0 Village Town of: State Plan Transition ID#: <br /> 41-e Dak/Ls Da Ali- <br /> CST BM EI6v: Insp BM Elev: BM Description: Parcel Tax No: <br /> 100 oo SAME 4ML. /A1 D AJ8L-E R6f) OAK O D-g3'-aq-Q�7co <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Septic s'KA in/ . /000 G Benchmark /,6)0 /0/60 /(X),CD <br /> Dosing <br /> Aeration Bldg.Sewer v 3,75 97.85 <br /> Holding St I Ht Inlet (p,82 5`f 78 <br /> TANK SETBACK INFORMATION St I Ht Outlet 7:02 <br /> TANK TO P/L i WELL BLDG VENT TO E ROAD Dt Inlet <br /> AIR INTAK <br /> Septic >25 ,V/A 15' — NA Dt Bottom <br /> Dosing NA Installation <br /> Contour <br /> Aeration NA Header/Man. 7.1l,, 9314 <br /> Holding Dist Pipe 7.77 '3,83 <br /> PUMP 1 SIPHON INFORMATION Infiltrative <br /> Surface 660 9�,Ln <br /> Manufacturer Demand Final Grade <br /> Model Number GPM <br /> TDH Lift Friction Loss System Head TDH Ft <br /> Forcemain Length Dia Dist.To Well <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width lD Length 54 No of Cells � Type of System Manufacturer: <br /> SETBACK OHWM of Nav Gonuenl;iona.l LEACHING <br /> P/L Bldg Well Waters CHAMBER <br /> INFORMATION <br /> =n young_ Model Number: <br /> CELL TO >,Zo ' /8' 04 > 75' <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes <br /> Length Dia Length Dia Spac Spacing 0 Yes 0 No <br /> SOIL COVER <br /> Depth Over Depth Over Depth of Seeded/Sodded Mulched <br /> Cell Center Cell Edges Topsoil 0 Yes 0 No 0.Yes 0 No <br /> COMMENTS: (Include code discrepancies,persons present,etc.) $u11-0006- �r WZgiQ, JJoT Cp+.VaIL' <br /> Permit Posted? �N AT r&mprcrIOJ. <br /> Schedule 40 Vents and Observation Pipes? N <br /> Bon/ tails Are @ i. S,+c. .41d <br /> 'TyPA►2 <br /> Cover Material:Effluent Filter Manufacturer zAlE3FL.. Model A -/8OD 31/S .en1 47.. vptr104 <br /> Components Not Inspected: <br /> Plan revision required?❑Yes 0 No `I 16,/ '04 <br /> 7 0 1 3 1 <br /> Use other side for additional information Date PO nspector's Sig re Cert No <br />