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AR.T Private Onsite Wastewater Treatment <br /> County <br /> � ° Burnett <br /> P Systems ( POWTS) Inspection Report <br /> (Attach to Permit) Sanitary Permit No: <br /> Industry Services Division SAN-25-24 <br /> General Information <br /> Personal information you provide may be used for secondary purposes Privacv Law,s 15.04 1 m <br /> Permit Holder's Name: Ll City Lj Village x Town of: State Plan Transaction ID#: <br /> Land & Cabin LLC Jackson 662170 <br /> CST BM Elev: Insp BM Elev: BM Description: Parcel Tax No: <br /> 100 Nail in double oak 6881 <br /> Tank Information setback to: <br /> TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road <br /> Septic Norwesco 1000 +2' NA 20' 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 2.0 102.0 100 <br /> Lifetime LT1/8 <br /> TDH Lift Friction Loss Head Total Bldg.Sewer 0.0 102.0 <br /> Forcemain Length Dia Dist.To Well <br /> Tank Inlet 5.15 96.85 <br /> Tank Outlet 5.50 96.5 <br /> Dispersal Cell Information Dose Tank Inlet <br /> DIMENSIONS Width Length #of Cells <br /> 3' 90, 1 Dose Tank Bottom <br /> SETBACK FROM Prop.Line Building Well OHWM Inst. Contour <br /> 5' 20' NA NA <br /> Header/Manifold <br /> Type of Cell Manufacturer: <br /> Distribution Pipe <br /> EZ-FLOW Model Number: Infiltrative Surface 7.0 95.0 <br /> EZ1203H <br /> Pretreatment Unit <br /> Final Grade 4.4 97.6 <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 I Topsoil ❑Yes ❑No [I Yes ❑No <br /> COMMENTS:(Include code discrepancies,persons present,etc.) <br /> Plan revision required? ❑ Yes IF]No 04 23 2025 1565671 <br /> Use other side for additional information. <br /> Date POWTS Inspector's Signature License Number <br /> SBD-6710(R.03/21) <br />