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Ilion `1 0<4-b(o IUWn <br /> PRIVATE ONSITE WASTE TREATMENT SYSTEMS Burnett Countv <br /> ( POWTS) Property Address:6-67 <br /> V&Consinr7 O INSPECTION REPORT • v21 f Dr.Department of Commerce <br /> sekry and BuilMnps Division (ATTACH TO PERMIT) Sanitary Permit No: <br /> GENERAL INFORMATION <br /> Personal infommtion you provide my be used Por sowndary f Privacy Law, <br /> Permit HokWs Name: U City Voltage Town of: State Plan Transaction IDM: <br /> .stn Wa lktr Oakland— <br /> CST BM Elev: Insp BM Elev: BM Description: Parcel Tax No: <br /> /00.(Do 5AMY- AIAIL IN RZZ OAK 30" Oab-4314-bb-3c0 <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Septic /{ 000 a u r Benchmaric X m o -0-29 kD-oo <br /> Dosing Co br w 00 czaafim 99.71 <br /> Aeration Bldg.Sewer <br /> Holding St/Ht inlet 4-18 45_4. <br /> TANK SETBACK INFORMATION St/Ht Outlet µ.b I 86'.)o <br /> rAerafion <br /> P/L WELL BLDG VENT TO ROAD Dt Inlet <br /> AIR INTAKE l 8/•1DI <br /> y%g > 9oj' NA Dt Bottom <br /> Installation <br /> >c� NA Contour <br /> NA Header/Man. <br /> Dist Pipe 3VliS7Infiltrati <br /> qd7 9hty <br /> PUMP 1 SIPHON INFORMATION Srface� 47oS�14 %.20, � <br /> Manufacturer &e Demand Final Grade <br /> Model Numberdsz GPM <br /> TDH Lift Friction Loss System Head TDH Ft <br /> Forcemain Length 2q5I Dia 201 Dist To Well > � <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width fp I Length jto I No of Cels 3 Type of System Manufacturer: <br /> ET <br /> SBACK P/L Bldg well oHwM or Nay LEACHING <br /> I <br /> INFORMATION g waters •.n jrourrcf. CHAMBER Model Number. <br /> CELL TO 5' > 300' >3m > 40 4jFT <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> Header/Manifold Distribution Pipes) N X Hole Size X Hole Observation Pipes <br /> Length_ Dia Lengthy Dia Spac Spacing 51'Yes ❑No <br /> SOIL COVER <br /> Depth Over Depth Over Depth of Seeded/Sodded Mulched <br /> Cell Center <br /> =Edges es To soil ❑Yes ❑No ❑Yes ❑No <br /> COMMENTS: (include code discrepancies,persons present,etc.) 5oIr-0iA.)G SES`+—' �s /u5u[hTEa7 <br /> Permit Posted? YvN <br /> Schedule 40 Vents and Observation Pipes?v N <br /> Cover Material: TYPAP. <br /> Effluent Filter Manufacturer z3wig - Model f7-0 822 <br /> Components Not Inspected: <br /> Plan revision required?❑Yes❑No 7 11�Iv7 D I I <br /> IZQ <br /> Use other side for additional information Date PO S Inspector's St re Cert No <br />