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` ---o �io <br /> PRIVATE ONSITE WASTE TREATMEN SYS MS Bumett County <br /> /SCO/1S'//1 ( POWTS) Property Address: <br /> 0 Department of Commerce INSPECTION REPORT <br /> ff,h ' T►�l�r <br /> Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No: <br /> GENERAL INFORMATION , 9 i $J�--) <br /> Personal information you provide may be used for secondary ses[Privacy Law,s.15.04(1 m)I `f I <br /> Permit Holder's Name: 0 City LJ Village Town of: State Plan Transaction ID#: <br /> M 6Lr V J06ns6n Ja-0 on -�- <br /> CST BM Elev: Insp BM Elev: BM Description: Parcel Tax No: <br /> J CO. 00 6ANI!� IVAI L uJ Rab PA 9 <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV <br /> Septic AV1/ /b,,.; Benchmark �.C> /0/.00 100.00 <br /> Dosing <br /> Aeration Bldg.Sewer A/A <br /> Holding St/Ht Inlet 4- 9 9 <br /> TANK SETBACK INFORMATION St/Ht outlet S <br /> TANK TO P/L WELL BLDG VENT To ROAD Dt Inlet <br /> AIR INTAKE <br /> Septic >SD ,/74' 1 — NA Dt Bottom <br /> Dosing NA Installation <br /> Contour <br /> Aeration NA Header/Man. <br /> Holding Dist Pipe-Ge//1 5,27 95.73 <br /> PUMP/SIPHON INFORMATION Infiltrative <br /> Surface •cell'! (a,3o 94. 70 <br /> Manufacturer Demand Final Grade <br /> Model Number GPM <br /> It z 6-157 903 <br /> TDH Lift Friction Loss System Head TDH Ft IWIM7149 ail 160 93.�0 <br /> Forcemain Length Dia Dist To Well <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS Width Length .F No of cells z Type of System Manufacturer: <br /> SETBACK p/L Bldg wall oHwM of Nav �� j LEACHING <br /> CHAMBER <br /> INFORMATION waters Model Number: <br /> CELL TO -0-?d W.57' IV14 <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> Header/Manifold Distribution Pipe(s) u X Hole Size X Hole Observation Pipes <br /> Length i.2' Dia Ae_ Length&!ja� Dia Spac — 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.) Ab& ,gyp fOCWYS accooy a 4oTS C 67-6 9J <br /> Permit Posted? (�r,> N A0 liucbu#•uwns To ELO AL rWo*Lry 8&-"AWje x <br /> Schedule 40 Vents and Observation Pipes? et, N <br /> Cover Material: `ryRAk- <br /> Effluent Filter Manufacturer AiQv ,E Model F'r'o 82Z <br /> Components Not Inspected: <br /> Plan revision required?❑Yes❑NolA� �5 p6 <br /> � C <br /> Use other side for additional information Date POV Inspector's Sig re Cert No <br />