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�, anrMw County <br /> Private Onsite Wastewater Treatment Burnett <br /> \sPs % Systems ( POWTS) Inspection Report <br /> (Attach to Permit) Sanitary Permit No: <br /> Industry Services ton SAN-23-56 <br /> General Information <br /> Personal infonnation you provide may be used for secondary u ses Privacy Law,s. 15.04(1)(m <br /> Permit Holder's Name: LJ City Lj Village x Town of: State Plan Transaction ID#: <br /> Jeffrey & Patricia Olson Trade Lake 650940 <br /> CST BM Elev: Insp BM Elev: BM Description: Parcel Tax No: <br /> Top of spike in small maple tree 1 23251 <br /> Tank Information setback to: <br /> TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road <br /> Septic Wieser loon +2' +25' +5' N/A <br /> Dosing Wieser 650 +2' +25' +5' N/A <br /> Aeration N/A <br /> Holding <br /> Pump 1 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 1.05 101.05 100 <br /> CiearFlow NSSCFF324 32.62 8/29/2023 5.57 105.57 <br /> TDH Lift Friction Loss Head Total Bldg. Sewer <br /> 17.52 3.007 3.25 23.78 <br /> Forcemain Length Dia Dist.To Well Tank Inlet 12.35 88.7 <br /> 155, 2" +25' Tank Outlet 12.49 88.56 <br /> Dispersal Cell Information Dose Tank Inlet <br /> DIMENSIONS Width Length #of Cells Dose Tank Bottom 15.8 85.25 <br /> 6.5' 50' 1 <br /> SETBACK FROM Prop.Line Building Well OHWM Inst.Contour <br /> +5' +10' +50' NA Header/Manifold 2.8 102.77 <br /> Type of Cell Manufacturer: <br /> Distribution Pipe <br /> Mound Model Number: Infiltrative Surface top of sand 3.1 102.47 <br /> Pretreatment Unit Final Grade 1.4 104.17 <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 3.2s' Dia 1.so" Length 4s.os' Dia 1.so" Spac 3.zs' .25" Spacing 3.70' 0 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 /> Tank installed 7/18/2023, mound installed 8/29/2023. <br /> Plan revision required? ❑Yes IKI No OS 29 2023 1565671 <br /> Use other side for additional information. <br /> Date POWTS Inspector's Signature License Number <br /> SBD-6710(R.03/21) <br />