Laserfiche WebLink
`A'► PRIVATE ONSITE WASTE TREATMENT SYSTEMS Burnett County <br /> .wonsin ( POWTS) Property Address:a—Cao <br /> Department of Commerce INSPECTION REPORTd 3S <br /> Safety and Buildings Division (ATTACH TO PERMIT) <br /> Sanitary Permit No: <br /> GENERAL INFORMATION <br /> Personal information you provide ma be used for secondary ses Pn yaw,s. 15.04 0 m) IASq <br /> 0(00 <br /> Peffn I Alders Nam1 City Village Tam of: State Plan Transaction ID#: <br /> I� �r I <br /> C --. M <br /> ST SM Elev: Insp BM lev: BM Description: Parcel Tax No: <br /> /00. o 6AM NAIL w rPeD RNE /D` OILS- 3�aP� Oa c� <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Septic '5x I ST r w C, C' 750 6A4coN Benchmark <br /> Dosingl 7',N /Do• Dt) <br /> T U. 500 c2NZ-0rJ Pc Riser 5.7(o <br /> Aeration Bldg.Sewer <br /> Holding St/Ht Inlet <br /> TANK SETBACK INFORMATION St/Ht Outlet <br /> TANK TO P/L WELL BLDG "E"r T <br /> AIR INTAKEO ROAD Dt Inlet <br /> Septic �* >,Zy . NA Dt Bottom <br /> Dosing NA Installation <br /> Contour <br /> Aerahon NA Header/Man. �r 8 98,2D <br /> Holding Dist Pipe <br /> PUMP/SIPHON INFORMATION Infiltrative <br /> Surface �.q$ 7/0 <br /> Manufacturer Demand Final Grade <br /> Model Number GPM <br /> TDH Lift Friction Loss System Head TDH Ft <br /> Forcemain Length Dia I Dist To Well <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width 3 Length 6C No of CeNs 2 Type of System Manufacturer: <br /> SETBACK P/L Bldg well OHWM of Nav �nven��onc.l LEACHING Z <br /> INFORMATION g Waters Tn-g.rnwo( CHAMBER Model Number. <br /> CELL TO 6e), 3,5' , "'//SFr .Z /203 t <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 To soil ❑Yes ❑No ❑Yes ❑No <br /> COMMENTS: (Include code discrepancies,persons present,etc.) <br /> Permit Posted? (Y) N <br /> Schedule 40 Vents and Observation Pipes? (D N <br /> Cover Material: 7WAR <br /> Effluent Filter Manufacturer , /rt Model /y/A <br /> Components Not Inspected: <br /> Plan revision required?❑Yes❑No 3 �� <br /> 7 0 t 3 1 <br /> Use other side for additional information Date POWT nspector's Signatu Cert No <br />