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County <br /> Private Onsite Wastewater Treatment <br /> $Ps J Systems ( POWTS) Inspection Report Burnett <br /> (Attach to Permit) Sanitary Permit No: <br /> Industry Services Division <br /> General Information SAN-24-245 <br /> Personal infonnation you provide may be used for secondary u ses Privacy Law,s. 15.04 1 m <br /> Permit Holder's Name: City U Village X Town of: State Plan Transaction ID#: <br /> Jeff Rockwood La Follette 662101 <br /> CST BM Elev: Insp BM Elev: BM Description: Parcel Tax No: <br /> 100' Nail in 12" Oak 9637 <br /> Tank Information setback to: <br /> TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road <br /> Septic Infiltrator 1060 +Z' 4-2 1j 4S N/A <br /> Dosing 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 /> Filter Manufacturer Filter Model GPM Benchmark 0.08 100.08 100 <br /> U t-T V 8 <br /> TDH Lift Friction Loss Head Total Bldg. Sewer 3.34 96.74 <br /> Tank Inlet 3.50 96.58 <br /> For(emain Length Dia Dist.To Well <br /> Tank Outlet 3.62 96.46 <br /> Dispersal Cell Information Dose Tank Inlet <br /> DIMENSIONS Width 3 Length #of Cells ,L Dose Tank Bottom <br /> SETBACK FROM Prop.Line Building Well OHWM Inst.Contour <br /> 5' + ' f`�'D +50 Header/Manifold <br /> Type of Cell Manufacturer: <br /> Distribution Pipe 4.50 95.58 <br /> Chambers Model Number: Infiltrative Surface Upper-)5.58 Lower-%5.68 94.5/94.4 <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 Length Dia Spac 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 /> Plan revision required? ❑YesXNo 9 25 2024 �s(e5Co <br /> Use other side for additional information. <br /> Date POWTS Inspector's Signature License Number <br /> SBD-6710(R.03/21) <br />