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"` '� PRIVATE ONSITE WASTE TREATMENT county: Burnett <br /> t ! SYSTEMS <br /> ti, s ( POWTS) //y3 <br /> j` INSPECTION REPORT Address:414 i G N <br /> Safety and Buildings Division (ATTACH TO PERMIT) <br /> Sanitary Permit No: <br /> GENERAL INFORMATION 6-.r,0 13 <br /> Personal information you provide may be used for secondary puT2ses[Privacy Lew,s. 15.04(1 xm)j -J-5-- <br /> Permit Holder's Name: EI City L1 Village Town of: State Plan Transaction ID#: <br /> C Axa Sw'i'ss CONN <br /> Insp BM Elev: BM Description: Parcel Tax No: <br /> 47-0A-a?- 4i-/6 -13- <br /> 1L �'oS-DOS- D/3� <br /> f.]O//o.,1 o t S�.:v d,v /Viii-2/w/f (mer e <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Septic G )V) 75o Benchmark a2• a D D m•06 <br /> Dosing <br /> Aeration Bldg.Sewer ] 0 S gs.1A <br /> Holding St ly Inlet ' 7s V 86 <br /> TANK SETBACK INFORMATION St I kIf Outlet 7,1"& ,6 4 <br /> TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet <br /> AIR INTAKE <br /> Septic 710 7 aS, (o' NA Dt Bottom <br /> Dosing NA Installation <br /> Contour <br /> Aeration NA Header 1 Man. <br /> Holding Dist. Pipe 7(p3 , 57 <br /> PUMP I SIPHON INFORMATION Infiltrative Ca (Po9 .(00 <br /> Surface <br /> Manufacturer Demand Final Grade <br /> Model Number GPM <br /> TDH Lift Friction Loss Sys Head TDH Ft <br /> Forcemain L Dia Dist.To Well Top of lid <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS W .3 L go ' #of Cells j Type of System.. Distribution Media Manufacturer: <br /> SETBACK OHWM of Nav Conv `: ❑ Aggregate �12 AZoml <br /> INFORMATION P I L Bldg Well Waters 11 IGP ❑ Chamber Model Number: <br /> ❑ AG ji% EZFIow <br /> CELL TO 7/01 3a' 9sp` 7 l ' ❑ Mound ❑ Other Z' 7 3 <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/Sodded Mulched <br /> Cell Center Cell Edges Topsoil g Yes ❑No ❑Yes ❑ No <br /> COMMENTS: (Include code discrepancies, persons present, etc.) Elevations taken with Wo'de —SAAwe r I(nZ-z <br /> Filter Manufacturer: Zshll'we <br /> Model: L-7- fV <br /> Electrician: <br /> (Field directive given to plumber that all electridwiring when necessary to be completed by electrician per WI Admin Code.) ❑Yes❑No <br /> Plan revision required?❑ Yes tNo <br /> Use other side for additional information d Date POWTS Inspector's Signature Certification Number <br /> SBD-6710(R.4114) <br />