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PRIVATE ONSITE WASTE TREATMENT <br /> SYSTEMS county: Burnett <br /> 4\ ( POWTS) 599q <br /> INSPECTION REPORT Address: AigJer <br /> Safety and Buildings Division (ATTACH TO PERMIT) <br /> Sanitary Permit No: SS87/V <br /> GENERAL INFORMATION <br /> Personal information you pmvide may be used for secondaryses Privet Law,s. 15.04(1 Xm) sj f/j/-/ - y0 <br /> Permit Holder's Name: City Village Town of: State Plan Transaction ID#: <br /> 'rG U/iLSoRI r S�' alb aiv CovN74y /fV;toW <br /> Insp SM Eley. BM Description: / !,, / / c Parcel Tax No: <br /> dD//e/r7 of ?��/A/d .SauN GAS CoY/Ve, fll,,e o7-ciao-a-va-/6-a�l-y o3' <br /> J Oo0-0///Qo <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> septic Q Benchmark <br /> Dosing <br /> Aeration Bldg.Sewer <br /> Holding St l Wlnlet Z/0 97.Sa <br /> TANK SETBACK INFORMATION StIWOudet 97a9 <br /> NTTO <br /> TANK TO P/L WELL BLDG A RINTA,KE ROAD Dt Inlet <br /> Septic ids' >a r' 3o' NA Dt Bottom <br /> Dosing' NA Installation <br /> Contour <br /> Aeration NA Header/Man. <br /> Holding Dist.Pipe <br /> PUMP/SIPHON INFORMATION Infiltrative <br /> Surface <br /> Manufacturer Demand Final Grade <br /> Model Number GPM <br /> TDH Lift Friction Loss TSys Head TDH Ft <br /> Forcemain L I Dia I Dist.To Well Top of lid <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS W L #of Cells Type of System Distribution Media Manufacturer. <br /> SETBACK OHWM of Nav ❑ Conv ❑ Aggregate <br /> INFORMATION P/L Bldg Well Waters D IGP ❑ Chamber Model Number: <br /> ❑ AG ❑ EZFlow <br /> CELL TO ❑ Mound o Other <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_ Spa c _ Spacing ❑Yes ❑No <br /> SOIL COVER <br /> Depth Over Depth Over Depth of Seeded/Sodded Mulched <br /> Cell Center Cell Edges Topsoil ❑Yes 11 No ❑Yes ❑No <br /> COMMENTS: (Include code discrepancies,persons present,etc,) Elevations taken with 2 RAgAOLA4 <br /> lJP/J614re4few-/- AV Filter Manufacturer: 'S;m Al& <br /> Model: <br /> Electrician: <br /> (Field directive given to plumber that all electric/mining Me necessary to b completed b electrician per WI Admin Code. ❑ No <br /> Plan revision required?❑Yes No $ �d �� �p10 8 3�? <br /> Use other side for additional information Date POWTS Inspector's Signature Certification Number <br /> SBD-6710(R_41141 <br />