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PRIVATE ONSITE WASTE TREATMENT SYSTEMS Bumett County <br /> Ais�onsin <br /> ( POWTS) Property Address:INSPECTION REPORT <br /> Department of Commerce ' <br /> Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No: <br /> GENERAL INFORMATION q 9 q,4 <br /> Personal information you vide may be used for recon res Pri Law,s. 15.04(I m) <br /> PTHolder's Name: City Village of: Stye Plan Transaction IDrF: <br /> CST BM Elev: Insp BM Elev: BM Description: Parcel Tax No: <br /> /00. 00 SAME AIL W LSD OAK )4-" Dao-�.3oZS OI- <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION FBS HI FS ELEV <br /> Septic S AIA J 800 Cz410A) Benchmark 4-- 30 10 /Oo.co <br /> Dosing <br /> Aeration Bldg.Sewer -7 7!0 <br /> Holding St I Ht Inlet 8-o7 <br /> 9(23 <br /> TANK SETBACK INFORMATION St I Ht Outlet g,27 �0 0 <br /> TANK TO P/L WELL I BLDG I <br /> VENr TAIR INTAKE ROAD Dt Inlet <br /> Septic -10d 4/1A 18 — NA Dt Bottom <br /> Installation <br /> Dosing NA Contour <br /> Aeration NA Header!Man. <br /> Holding F Dist Pipe g.3,2, 93.91!3 <br /> PUMP/SIPHON INFORMATION Infiltrative 94195 <br /> Surface 9. 35 <br /> Manufacturer Demand Final Grade <br /> Model Number GPM <br /> TDH Lift Friction Loss System Head TDH Ft <br /> Forcemain Length Dia I Dist To Well <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width ,3 Length cam• No of cells f Type of System Manufacturer: <br /> SETBACK Co+we r6cavtl LEACHING E Z F-1-01w <br /> OHWM of Nay <br /> INFORMATION P/L Bldg well Waters 1n,9�md CHAMBER Model Number. <br /> CELL TO K s 35'+ N/A x9i E Z <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes <br /> Length Dia I Length_ Dia_ Spac Spacing Yes ❑No <br /> SOIL COVER <br /> Depth of Seeded!Sodded Mulched <br /> Depth Over Depth Over <br /> Cell Center Cell Edges Topsoil <br /> ❑Yes ❑No ❑Yes ❑No <br /> COMMENTS: (include code discrepancies,persons present,etc.) <br /> Permit Posted? T N <br /> Schedule 40 Vents and Observation Pipes?(Y) N <br /> Cover Material: TyPAPL <br /> Effluent Filter Manufacturer F roToaze Model ,;STD 02Z <br /> Components Not Inspected: <br /> Plan revision required?❑Yes❑No ,7 S� FTirO 1 3 1 <br /> Use other side for additional information Date &P0jWTInspector`s Signal Cert No <br />