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Tg , `f- v <br /> PRIVATE ONSITE WAST�TREATMENT SYSTEMS Bumett County <br /> Visconsin ( POWTS) Property Addres 7 <br /> Dezartr�t of Commerce INSPECTION REPORT ,�, Lh <br /> Sa"and 6dildings Division (ATTACH TO PERMIT) <br /> Sanitary Permit No: <br /> GENERAL INFORMATION <br /> Personal information you provide ma be used for seconPri Law,s.15.04 1 m) S 7 <br /> Permit Holder's Name: City <br /> ses Village own of: State Plan Transaction ID#: <br /> ►� Mle`Pirt, g <br /> CST BM Elev: IAIL <br /> SM Elev: BM Description: Parcel Tax No: <br /> /00- 00 S Mi~ IL In) tYAC.IC- I�IAIE <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE7 MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Septic IA) 7,50 &,u. Benchmark I;if ln(�50 /Oo• 00 <br /> Dosing nr <br /> L <br /> Aeration Bldg.Sewer g/7 9(v. 33 <br /> Holding St/Ht Inlet $q 95. 59 <br /> TANK SETBACK INFORMATION St/Ht Outlet <br /> TANK TO P/L WELL BLDGIAR INTAKE ROAD Dt Inlet <br /> Septic >/00 VIA Z,za NA Dt Bottom S Z <br /> Dosing " > 2d NA Installation <br /> Contour G. 98.0 <br /> Aeration NA Header/Man. 99 09 <br /> Holding Dist Pipe S• I O <br /> PUMP I SIPHON INFORMATION Infiltrative <br /> Surface (o,0(P <br /> �09- <br /> Manufacturer 1472E G/ rJT zZ d8 Demand Final Grade <br /> Model Number cr 6 14 &1, GPM <br /> TDH Liftk4 Friction Loss ,50System Head 3,�5 TDH/c.36Ft <br /> Forcemain Length 4* Dia iml Dist To Well <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width 7 Length 43 No of Cells I Type of System Manufacturer. <br /> SETBACKaNyyM oNav Wow W LEACHING <br /> INFORMATION P/L Bldg <br /> well waters CHAMBER Model Number. <br /> >,?4 rncJles <br /> CELL TO >wa x !�$ Nr1, — In S►Ev Sw( <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> Header I Manifold Distribution <br /> �( Pjpe(s) X Hole Size X Hole Observation Pipes <br /> Length 3.0 Dia /'"f Length � Dia 1114 Spac 3 .18V Spacing cy 12'Yes ❑No <br /> SOIL COVER <br /> Depth Over Depth Over Depth Seeded/Sodded Mulched <br /> Cell Center /-0 Cell Ed es 0• So Topsoil x 4" IkYes ❑No (s3 Yes ❑No <br /> COMMENTS: (include code disaeparicies,persons present,eta) <br /> Permit Posted? ly N <br /> Schedule 40 Vents and Observation Pipes? Ye N <br /> Cover Material: _WPAP, <br /> Effluent Filter Manufacturer .7A 6eL— Model A - i 8 UO <br /> Components Not Inspected: <br /> Plan revision required?❑Yes❑No �!� t �P <br /> Use other side for additional information Date t/� POWT spectors Sign Cert No <br />