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wed '6-1s-o r is 3a <br /> PRIVATE ONSITE WASTE TREATMENT SYSTEMS Burnett county <br /> Visconsin <br /> ( POWTS) Pmpaty Address: <br /> Department of Commerce INSPECTION REPORT <br /> S° 'anti&'IBloa'OiNcan (ATTACH TO PERMIT) <br /> Sanitary Perms No: <br /> GENERAL INFORMATION <br /> Persoml information you vide may be used for sewn Privacy Law,s. 15.04 1 m <br /> Permit okWs Name: City Village Town of: State Plan Transaction IDN: <br /> CST BM Elew InaP B I BM Description: Parcel Tax No: <br /> '/00, 00 5Atli AJAIL JAJ RZZ ,NF . al - <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Septic 1ESE2 Q (o„ Benchmark -0,40 019, (0 co <br /> Dosing <br /> Aeration Bldg.Sewer x 502.0 <br /> Holding St/Ht Inlet <br /> TANK SETBACK INFORMATION St/Ht outlet <br /> TANK TO P/L WELL BLDG VENT TO ROAD DIInlet <br /> AIR INTAKE <br /> i <br /> c NADt Bottom <br /> ng NA Installation <br /> Contour <br /> ion NA Header/Man. <br /> Holding Dist Pipe 92.4 <br /> PUMP I SIPHON INFORMATION Infiltrative <br /> Surface 0-06119 . <br /> Manufacturer Demand Final Grade a <br /> Model Number GPM <br /> MH Lift Friction Loss System Head TDH Ft <br /> Forceman Length Dia I Dist To Well <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width 3 Length No of cells Type of System Manufacturer. <br /> bw�al LEACHING � �4O <br /> INFORMATIION P/L Bldg Wei water aN� CHAMBER <br /> In 9�ot Model Number. <br /> CELL TO 7/0 ' >,5D' > <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> Header/Manifold Distribution Pipe(s) X Hole Size X Hole Obseivation Pipes <br /> Length Dia Length_ Dia_ Spac Spacing 21es ❑No <br /> SOIL COVER <br /> SOIL <br /> Depth Over Depth of Seeded/Sodded Mulched <br /> Ceti Center Cell Edges To 'I ❑Yes ❑No 1 ❑Yes ❑No <br /> COMMENTS: (include code discrepancies,persons present,etc.) 31ATLDAtrs S eaAIU Abr G.14A-67C At =AWdC7)c t) <br /> Permit Posted? 0 N <br /> Schedule 40 Vents and Observation Pipes�Y N <br /> Cover Material: k- <br /> EfFluent Filter Manufacturer Lo cFt. Model 52,5 <br /> Components Not Inspected: <br /> Plan revision required?❑Yes❑No 1I <br /> 3 <br /> Use other side for additional information Date OWTS pector s Signatu Carl No <br />