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PRIVATE NSITE WAS REAT SYSTEMS Burnett County <br /> `�SCOn$%n ( POVVTS) Property Address: <br /> Department of Commerce INSPECTION REPORT Aj KS Q <br /> Safety and Buildings DiNsion (ATTACH TO PERMIT) <br /> Sanitary Permit No: <br /> GENERAL INFORMATION L(! -9767 <br /> Personal information you provide my be used for wcandary s I Privacy Law,s. 15.04 t m) <br /> Pend Holders Name: n^ LI City Yllage Town of: State Plan Transaction IDk: <br /> /unnl� <br /> CIVAM-Elev: Insp BM Elev: BM Description: Parcel Tax No: <br /> /b 6Ah4E NAIL nlI Wf 4 dAIC 3 1— <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Septic SFIAVJ UO C3.1GGrn.) Benchmark 33 %. /00.00 <br /> Dosing 4416 750 G4ao,3 <br /> Aeration Bldg.Sewer 7-M 8 , 64 <br /> Holding St/Ht Inlet <br /> TANK SETBACK INFORMATION St I Ht Outlet dlz Ai, <br /> TANK TO PA- WELL BLDG VENT TO ROAD Dt Inlet <br /> AIR INTAKE <br /> Septic 7i0d >/pp > 95' NA DtBottom 13, 9 <br /> Installation <br /> Dosing _ _ 75, NA Contour <br /> Aeration NA Header/Man. <br /> Holding Dist Pipe 3.42 93.zs <br /> PUMP 1 SIPHON INFORMATION Infiltrative <br /> surface 4..75 92.¢ <br /> Manufacturer o e2 astir Demand Final Grade <br /> Model Number N .�3 GPM W r n <br /> /12 55- 75 <br /> TDH Uft155 Friction Loss 432System Head TDHaIS$Ft <br /> Forcemain Length 1gol Dia g-1 Dist.To Well a ioo' <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width 3' Length jeol No of call Type of System Manufacturer: <br /> SETBACK OHWM of Nay no6r / LEACHING �z ��uJ <br /> INFORMATION P I L Bldg wee waters TA-5�d CHAMBER Model Number. <br /> CELL TO >/00 >ico' >Zcy,' VIA /-tFT Ez 1203 H <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> Header I Manifold Distribution Pipe(s) X Hole Size X Hole I Observation Pipes <br /> Length_ Dia_ Length_ Dia_ Spac_ Spacing I 0 Yes ❑No <br /> SOIL COVER <br /> Depth Over Depth Over Depth of Seeded I Sodded Mulched <br /> Cell Center Cell Edges To it ❑Yes ❑No ❑Yes ❑No <br /> COMMENTS: (Include code discrepancies,persons present,etc.) ,$olr..0,,f, �ci rs weu. Aovc d F>Qar oifor6cna>v P4'rtl Ar <br /> Permit Posted? (y) N TUE ' u OL*,rcm Ar sk440 o440'0 A/6,e. -11 A10 <br /> Schedule 40 Vents and Observation Pipes N <br /> Cover Material: 2VA4 <br /> Effluent Filter Manufacturer ,zA66L. Model A -/oo - b' <br /> Components Not Inspected: <br /> Plan revision required?❑Yes❑No �- Z O / 3 <br /> Use other side for additional information Date OrOWTS 1WS Signature Cert No <br />