Laserfiche WebLink
Visconsin <br /> PRIVATE ONSITE WASTE TREATMENT SYSTEMS Burnett County <br /> ( POWTS) Property Address: <br /> De0artment of commerce INSPECTION REPORT .SeGaw.G <br /> Safety and Buildings Division Jh* /� (ATTACH TO PERMIT) <br /> (, g ' f Sanitary Permit Na: <br /> GENERAL INFORMATION t �• � <br /> Personal information you provide may be used for recon u Priv Law,s. 15.04 1)(m) <br /> Pe Holder's Na e: �� / State Plan Transaction IDM: <br /> ` Town of. C <br /> C BM Elev: Insp BM Elev: lJ BM Description: <br /> Parcel Tax No: J <br /> /X.010 c5Ab1E NAI[. JJ QuJE .eo- 6a 5c-x <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Septic ,qLA) 6Ar--- Benchmark I.C24 /01, 04- I • O <br /> Dosing <br /> Aeration Bldg.Sewer 70/ 9 03 <br /> Holding St/Ht Inlet 7. /B 9 AP <br /> TANK SETBACK INFORMATION St/Ht outlet 7.38 7S. <br /> TANK TO P/L WELL I BLDG VENT To ROAD Dt Inlet <br /> AIR INTAKE <br /> Septic >50 NA Dt Bottom <br /> Dosing NA Installation <br /> Contour <br /> Aeration NA Header/Marr. <br /> Holding Dist.Pipe 7.77 <br /> PUMP I SIPHON INFORMATION System <br /> Elevation 9.40 9z 44 <br /> Manufacturer Demand Final Grade <br /> Model Number GPM <br /> Lift Fr.Loss Head TDH <br /> Forcemain Length Dia Dist/Weil <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width 6 Length SC No a Cell z Type of System Manufacturer: <br /> SETBACK OHof Nav LEACHING <br /> INFORMATION P/L Bldg well waters �� CHAMBER Model Number: <br /> CELL TO 7 Alli — <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> Header I Manifold Distribution Pipes) X Hole Size X Hole Observation Pipes <br /> Length — Dia — Length–4k Dia LP Spec Spacing ❑Yes ❑No <br /> SOIL COVER <br /> Depth Over Depth Over Depth of Seeded/Sodded Mulched <br /> Cell Center Cell Edges Topsoil ❑Yes ❑No ❑Yes ❑No <br /> COMMENTS: (Include code discrepancies,persons present,etc.) <br /> Components Not Inspected <br /> Rt Permit Posted Cover Material JP Ail <br /> p' Warning labels on manhole covers w/locks <br /> w Schedule 40 Vent Material <br /> m/ Effluent Filter installed Model A-1800 -1AFR. 2,o�CC <br /> Plan revision required?❑Yes❑No �� !� vo' p I 3 <br /> Use other side for additional information Date 'P(5v#Inspector's Signature Cert No <br /> Bureau of Field Operations,PO Box 7302,Madison,WI 53701-7302 SBD-6710 (31011) <br />