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PRIVATE 61 itrIlt WASTE TREATMENT SYSTEMS Burnett County <br /> lkconsin ( POWTS) Property Addrm: <br /> Department of Commerce INSPECTION REPORT <br /> Sakty and&"Id'ags Divism (ATTACH TO PERMIT) Plellg��Uja ` <br /> Sanitary Permit No: <br /> GENERAL INFORMATION <br /> Personal iufomwtion YouPfmdc MY be used for wcOndarY om I Primicy Law,s. 15.04 1 m) <br /> Perm!HPkkWs Name: U City U village Town of State Plan Transaction IDk: <br /> e( l <br /> CST BM Elew Inap BM E . BM Description: I <br /> Parce <br /> 00.00 S,aM� TP or SA.'/SA.'/ z"-4P' — of LParcel Tax No: <br /> or <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI ---F—S--T ELEV <br /> Septic S q/�p Benchmark C70 /OS 100.00 <br /> Dosing <br /> Aeration Bldg.Sewer <br /> G•5 <br /> Holding /f.114 <br /> St/Ht Inlet 7 97-36 <br /> TANK SETBACK INFORMATION St/Ht Outlet 795 97 6 <br /> TANK TO P/LWELL BLDG �NT°E ROAD Dt Inlet <br /> Septic 1.2' >/Gtr J — NA Dt Bottom <br /> Dosing NA Installation <br /> Contour <br /> Aeration NA Header/Man. 8.3 %• <br /> Holding Dist Pipe <br /> i <br /> PUMP/SIPHON INFORMATION Infiltrative <br /> Surface 9.90 (KI ¢p 95./0 <br /> Manufacturer Demand Final Grade <br /> Model Number GPM -rop OFG"w ,9.9 96.07 <br /> MH Lift Friction Loss System Head MH Ft .57,SIH ifw. 5,70 9• D <br /> Foroemain Length Dia I Dist To Well <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width 3 Length. No of Cans Type of System Manufacturer. <br /> INFORMATION ION P I L Bldg wall CK OHM of Na" ConVa 1&W1 LEACHAMBER <br /> TM To 2 <br /> watem T�_g god„3 Model Number. <br /> CELL TO �vr�r <br /> DISTRIBUTION SYSTEM X Pressure Systems only <br /> Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes <br /> Length 2e Dia q~ Length_ Dia_ Spac Spacing 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,eta) <br /> Permit Posted? (Y) N <br /> Schedule 40 Vents and Observation Pipes?& N <br /> Cover Material: NIA <br /> Effluent Filter Manufacturer Model A—loo -/L <br /> Components Not Inspected: <br /> Plan revision required?❑Yes❑No <br /> Use other side for additional information Date POWTS s Signalu Cert No <br />