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Asconsin <br /> PRIVATE ONSITE WA E TREATMENT SYSTEMS Bumett County <br /> ( POWTS) Property Address: I go <br /> Department of Commerce INSPECTION REPORT 6 , <br /> / Sarery and Buildings Dimmer, (ATTACH TO PERMIT) Sanitary Permit No: <br /> GENERAL INFORMATION <br /> Personal information you provide my be used for seoondary pu f Privacy w,s. 15.04(1 in / <br /> Perm oldee N Li City Village own of: State PI a Transaction IDN: <br /> r ` n -sIl <br /> CST BM Elev: Insp BM Elev: BM Description: Parcel Tax No: <br /> 100- 00 )9Mz!�. JQli Ig R>:#) DAK /s Oau-3I/D 1' <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY I STATION I BS HI FS ELEV <br /> Septic /EsfR Benchmark 60co <br /> Dosing Comtr ro>` l 00 CIA l OZ.2d 1 /00 cc) <br /> Aeration Bldg.Sewer — <br /> HOlding St/Ht Inlet <br /> TANK SETBACK INFORMATION St/Ht Outlet <br /> TANK TO P/L I WELL BLDG vE111 TO ROAD Dt inlet <br /> AIR INTAKE <br /> Septic NA Dt Botlom 96 <br /> Installation <br /> Dosing ' >2or NA Contour <br /> Aeration NA Head I Man. <br /> Holding Dist Ripe S.ss 1414 <br /> InfittrPUMP I SIPHON INFORMATION Surfa ve <br /> Surface &7oo 93.o0 <br /> Manufacturer ,Z #0 Demand Final Orade <br /> Model Number /.37 sr Ys PM TwWaoG PD.WT <br /> TDH Lift1Z5 Friction Loss 6,931 System Head 1 TDH,6.4 t <br /> Folcemain Length,?p Diaq- Dist To Well > ��. <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS I Width 3 t Length 131 1No of cans Type of System Manufacturer. <br /> �on�erE4waf LEACHING T1JGiLTr2tTC <br /> SETBACK P I L Bldg wen oNwM Nay LEACHING <br /> INFORMATION waters )n�'rant( Mod umber. <br /> CELL TO �/op' >/W' WCo I > �/ I LFT Ulc K <br /> DISTRIBUTION SYSTEM XP systems 0 ly <br /> Header I Manifold Distribution Pipe(s) X Hole Size X Hi Ile Observation Pipes <br /> Length_ Dia Length_ Dia_ Spec_ Sp 'ng ❑Yes ❑No <br /> SOIL COVER <br /> Depth Over Depth Over D Dth of Seeded/Sodded Mulched <br /> Ceti Center Cell Ed es T soil 0 ❑No ❑Yes ❑No <br /> COMMENTS: (Include code discrepancies,persons present,etc.) h OT6r 0216WhL I?LAfO LO&S 0, DES/6A) POL .28 S45&5- <br /> Permit Posted? N 14 of- Tna SIT-es L w MW , t6A 06/�tmA "S <br /> be <br /> Schedule 40 Vents and Observation Pipes?(gypN c /a'll' Au° `«•` DacxC4W. TNS 59L <br /> 4-cotorw C61,t.5 Mac IPYWAU40 As Q/t P$ 0, b,t <br /> Cover Material: MA 5ed6,rr. -rwl- ,pro A: mp Cw,µ66rL r, 6t& r1*d& "j <br /> Effluent Filter Manufacturer M el A-too-fa s,ze. <br /> Components Not Inspected: <br /> Plan revision required?❑Yes❑No 167 Q5 7 D t <br /> Use other side for additional information Date jPOS Inspector's S' ature Cert No <br />