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PRIVATE ONSITE WASTE TREATMENT SYSTEMS Bunnett County <br /> Wisconsin ( POWTS) Property Address: <br /> Department of Commerce INSPECTION REPORT Also sr 4wy 7D <br /> Safety and Buildings Division (ATTACH TO PERMIT) <br /> Sanitary Permit No: <br /> GENERAL INFORMATION 415/5/ <br /> //��� <br /> Personal information you vide may be used for secondarys PrivacyLaw,s. 15.04(1 m ?'rte 8/5/ <br /> Permd Holders Name: City Village IZTown of: State Plan Transaction ID#: <br /> 10M 6�13LAEK ).AFaJ4rr6 <br /> CST BM Elev: Insp BM Elev: BM Description: <br /> ` Parcel Tax No: <br /> /00. DO 5AAV <br /> µ6 AIL w w-re- Pwe- 3o` o4vc) 05 7 <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Septic 5KAW 800 (-3AU0A) Benchmark -2.Ilo 97.34 IC0100 <br /> Dosing <br /> Aeration Bldg.Sewer 3.91 93.93 <br /> Holding St/Ht Inlet 4. 40 1 93.44 <br /> TANK SETBACK INFORMATION St/Ht Outlet 91,24 <br /> TANK TO P/L WELL I BLDG VENT To ROAD Dt Inlet <br /> AIR INTAKE <br /> Septic >30 >35, ,?D NA Dt Bottom <br /> Dosing NA Installation <br /> Contour <br /> Aeration NA Header/Man. <br /> Holding Dist Pipe &5 93.19 <br /> PUMP I SIPHON INFORMATION Infiltrative <br /> Surface 5.60 <br /> Manufacturer Demand Final Grade <br /> Model Number GPM <br /> MH Lift Friction Loss System Head TDH Ft <br /> Foroemain Length Dia I Dist To Well <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width 3 Length 11No of Cels I Type of System Manufacturer: <br /> SETBACK OHWM of Nav Con✓ei'bonal LEACHING t310 D I WFv 56+2 <br /> INFORMATION P/L Bldg well WatersCHAMBER <br /> ?r,-�,•cu,c(„ Model Number. <br /> CELL TO % ,Z0• > SO A3o' 5TAWAaD 114 Cwt yor l c, <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> Header/Manifold Distribution Pipes) 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 j Mulched <br /> Cell Center I Cell Edges Topsoil ❑Yes ❑No ❑Yes ❑No <br /> COMMENTS: (Include code discrepancies,persons present,etc.) I NSTAL,Eo (g? 54 So1L AWUCer/awv ODM. Z <br /> Permit Posted? (Y) N <br /> Schedule 40 Vents and Observation Pipes? 1( N <br /> Cover Material: N 1 A <br /> Effluent Filter Manufacturer -ZA60u— Model A-/500 <br /> Components Not Inspected: <br /> Plan revision required?❑Yes❑No �O hbv OR' 7 � O / 3 !' <br /> Use other side for additional information Date POWTS Ins or's Signature Cert No <br />