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°. e- PRIVATE ONSITE WASTE TREATMENT <br /> 1 <br /> SYSTEMS County: Burnett <br /> � <br /> ( POWTS) 29� INSPECTION REPORTQ <br /> Safety and Buildings Division Address: f�ex/Lk /f G(. <br /> (ATTACH TO PERMIT) U <br /> GENERAL INFORMATION Sanitary Permit No: S$(p(p 7 <br /> Personal information ou provide may be used for secondary purposes[Privacy law,s. 15.04(1 Xm)I <br /> Permit Holder's Name: ❑City 0 Village Town of: State Plan Transaction ID#: <br /> �owar !/atl5Gaju Gov.t•f'y eve;w <br /> Insp BM Elev: BM Description: S4ov ale :re r Parcel Tax No: <br /> I aT-o2a-2-9a-Flo "08-I <br /> - <br /> TANK INFORMATI N ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Septic S OL 0 D 0 Benchmark /02.Sy /06-06 <br /> Dosing <br /> Aeration Bldg.'Sgwer S,a 97, 50 <br /> Holding St/Winlet S / 97 YO <br /> TANK SETBACK INFORMATION St/)R Outlet <br /> TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet <br /> AIR INTAKE <br /> Septic 70& meso' NA Pt Bottom <br /> Dosing NA Installation <br /> Contour <br /> Aeration NA Header/Man. <br /> Holding Dist.Pipe :57:rig F6.96 <br /> PUMP/SIPHON INFORMATION Infiltrative <br /> Surface <br /> E <br /> nufacturer Demand Final Grade <br /> del Number GPM <br /> TDH Lift Friction Loss jSys Head TDH Ft <br /> Forcemain I Dia I Dist.To Well TopofQjtl �StP $�{ /aa•5y <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS W L #of Cells Type of System Distribution Media Manufacturer: <br /> SETBACK OHWM of Nav ° Conv ❑ Aggregate <br /> INFORMATION P/L Bldg Well Waters G ❑ Chamber Model Number: <br /> ❑ FZFIovv <br /> CELL TO ❑ Mound ❑ Other <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> Header I 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 I Sodded Mulched <br /> Cell Center Cell Edges Topsoil ❑Yes ❑No []Yes ❑No <br /> COMMENTS: (Include code discrepancies,persons present,etc.) Elevations taken with JJ —le'ZIA-vier <br /> Filter Manufacturer: <br /> Model: <br /> Electrician: <br /> (Field directive given to plumber that all electric/wiring when ecessary to be ompleted by electrician per WI Admin Code.) ❑Ye <br /> Plan revision required?❑Yes 0 No a a X33 <br /> Use other side for additional information Date POWTS Inspector's Signature Certification Number <br /> SBD-6710(R.4/141 <br />