Laserfiche WebLink
"T PRIVATE ONSITE WASTE TREATMENT <br /> '3 SYSTEMS County: Burnett <br /> ( POWTS) -01- Sa83 <br /> INSPECTION REPORT Address: Yn41/ 61 GUes� <br /> Safety and Buildings Olvision (ATTACH TO PERMIT) <br /> GENERAL INFORMATION Sanitary Permit No: <br /> Personal information you provide may be used for secondary purpose [Privacy Law,s.15.04(1 xm) <br /> Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#: <br /> AvNe— Vo u)e LG � -- <br /> Insp BM Elev: BM Description: Parcel Tax No: <br /> /OD °° /1/;L Ave o7 o36-9-yo-��-as- <br /> s 0s- Do/-oa0000 <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Septic g�j Benchmark / S /0/,9S <br /> Dosing S"0 0 <br /> Aeration Bldg,Sewer 9y g'-1, 2. , <br /> Holding St IAA Inlet 2- <br /> TANK SETBACK INFORMATION St/bKOutlet 2. 3,ql y5".9 I <br /> TANK TO P/L WELL I BLDG VENTTO ROAD Dt Inlet <br /> AIR INTAKE <br /> Septic 7 ' y, S' (D' NA Dt Bottom 7- <br /> Dosing <br /> Installation <br /> 7 7;S 7' NA Contour <br /> Aeration NA Header/Man. <br /> Holding Dist.Pipe <br /> PUNIP/SIPHON INFORMATION Infiltrative Surface q j a 2 D6 <br /> Manufacturer L,'I e Demand Final Grade <br /> Model Number GPM <br /> TDH/yV/ Lift Friction Loss Sys Head TDH Ft %4 o�Z,`(z <br /> Forcemain L a p p Dia o2 'r IDist.ToWell > ,)S' Top of lid 6,M #L,2,qA Ph,--k ,0(0 <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS W ,� L /a #of Cells / Type of System Distribution Media Manufacturer: <br /> SETBACK OHWM of Nav Conv ❑ Aggregate z"Z `G oW <br /> INFORMATION P/L Bldg Well Waters ❑ IGP ❑ Chamber Model Number: <br /> ❑ AG R EZFIow <br /> CELL TO (p` 7 75" ' >�a` boo' ❑ Mound ❑ Other Ak 3 <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> Header/Manifold Distribution Pipes) X Hole Size X Hole Qbservation Pipes <br /> Length Dia Length Dia Spac Spacing Yes ❑No <br /> SOIL COVER <br /> Depth Over Depth Over Depth of Seeded/Sodded Mulched <br /> Cell Center Cell Ed es Topsoil ❑Yes ❑No ❑Yes ❑No <br /> COMMENTS: (Include code discrepancies,persons present, etc.) Elevations taken with 0 Z/1'1 <br /> Filter Manufacturer: G,'�t hm e <br /> Model: <br /> Electrician: <br /> (Field directive given to plumber that all electriclwirinq n necessary be completed by electrician per WI Admin Code.) ❑Yes❑No <br /> Plan revision required?❑Yes No �fl 17 <br /> Use other side for additional information Date POWTS Inspector's Signature Certification Number <br />