Laserfiche WebLink
c`I/-Off ro,� County <br /> n Private Onsite Wastewater Treatment Burnett <br /> K Systems ( POWTS) Inspection Report <br /> (Attach to Permit) Sanitary Permit No: <br /> Industry Services Division SAN-23-116 <br /> General Information <br /> Personal information you provide may be used for secondary u oses f Privacy Law,s.15.04 1 m <br /> Permit Holder's Name: Ij City Lj Village x Town of: State Plan Transaction ID#: <br /> Dean Hilgers Scott 654801 <br /> CST BM Elev: Insp BM Elev: BM Description: Parcel Tax No: <br /> Top of spike in tree 19446 <br /> Tank Information setback to: <br /> TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road <br /> Septic Wieser 840 10, 57' 25' N/A <br /> Dosing Wieser 500 10, 57' 25' N/A <br /> Aeration N/A <br /> Holding <br /> Pump/Siphon Information Elevation Data <br /> Pump Manufacturer Pump Model Demand STATION BS HI FS ELEV <br /> Liberty 280 Series <br /> Filter Manufacturer Filter Model GPM Benchmark 3.42 103.42 100 <br /> Clearflow NSSCFF324 25 <br /> TDH Lift Friction Loss Head Total Bldg.Sewer 6.0 97.42 <br /> 5.92 .417 3.50 9.837 <br /> Forcemain Length Dia Dist.To Well Tank Inlet 8.25 95.17 <br /> 30' 2" 67' Tank Outlet 8.3 95.12 <br /> Dispersal Cell Information Dose Tank Inlet <br /> DIMENSIONS Width Length #of Cells Dose Tank Bottom 11.91 91.45 <br /> 3.25' 25' 2 <br /> SETBACK FROM Prop.Line Building Well OHWM Inst.Contour <br /> +5' 40' 53' NA Header/Manifold 6.05 97.37 <br /> Type of Cell Manufacturer: <br /> Distribution Pipe <br /> GeoMat Model Number: Infiltrative Surface 5.58 97.84 <br /> Pretreatment Unit Final Grade <br /> Manufacturer: <br /> Model Number: <br /> Distribution System X Pressure Systems Only <br /> Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes <br /> Length Dia I Length Dia Spac I Spacing ❑Yes ❑ No <br /> Soil Cover <br /> Depth Over Depth Over Depth of Seeded/Sodded Mulched <br /> Cell Center Cell Edges Topsoil ❑Yes ❑No ❑Yes ❑No <br /> COMMENTS:(Include code discrepancies,persons present,etc.) <br /> hloW ' tr pl w <br /> Plan revision required? ❑Yes I@ No 08 08 2023 1565671 <br /> Use other side for additional information. <br /> Date POWTS Inspector's Signature License Number <br /> SBD-6710(R.03/21) <br />