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�� "`T""', PRIVATE ONSITE WASTE TREATMENT <br /> x, �'_- ~' County: Burnett <br /> / SYSTEMS <br /> tfis.,.. ti <br /> ( POWTS) <br /> `N°`° ✓ INSPECTION REPORT Address:24715 7hoNAR <br /> Safety and Buildings Division (ATTACH TO PERMIT) <br /> Sanitary Permit No: <br /> GENERAL INFORMATION 6,q,JJ-20.59 <br /> Personal information you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)) <br /> Permit Holder's Name:WdSth <br /> ❑City ❑ Village wn of: State Plan Transaction 104: <br /> fl4kC, cu, C6o vt. 62311(0 <br /> Insp BM Elev: BM Description: Parcel Tax No: <br /> 10D-00 Aid 114 22" lbrWavt33561 <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV <br /> Septic 1Uotrwt,Sco 1000 Benchmark <br /> 3.40 to3.4b too.o 0 <br /> Dosing <br /> Aeration Bldg,Sewer <br /> . Jzri ec9- — <br /> Holding St/Ht Inlet 6.32 96/.83 <br /> TANK SETBACK INFORMATION . St/Ht Outlet (o. 95 (1644.5 <br /> TANK TO P/L WELL I BLDG VENTTo ROAD Dt Inlet <br /> AIR INTAKE <br /> Septic >2.0' 50' 13' 50' NA Dt Bottom <br /> Dosing . NA Installation <br /> Contour , <br /> Aeration NA Header/Man. <br /> Holding Dist. Pipe <br /> PUMP/SIPHON INFORMATION Infiltrative 4.90 K 8D <br /> Surface <br /> M:- facturer D' ' Final Grade 6.40 q.8.0 <br /> Model N , ber GPM <br /> TDH Lift Friction Loss I Sys - TDH Ft <br /> Forcemain Dist.To Well Top of lid <br /> DISPERSAL CELL INFORMATION <br /> DIMENSIONS W 3' L 130' #of Cells I Type of System Distribution Media Manufacturer <br /> /), <br /> SETBACK OHWM of Nav f' Cony ❑ Aggregate 1—..LA -f"r' f <br /> INFORMATION P L Bldg Well Waters ❑ IGP o Chamber Model Number: <br /> ❑ AG -EZFlow ` <br /> CELL TO >20' 23' ?cop' 1 >56' ❑ Mound ❑ Other 3.x 10s <br /> DISTRIBUTION SYSTEM X Pressure Systems Only <br /> eader/Manifold D' X Hole Size Observation Pipes <br /> Le Length Dia I Spacing Yes ❑ No <br /> SOIL COVER oi- Codenoise cd +r'r.+.tc o•' ir,t.5pe t(o v\ <br /> Depth Over Depth Over — Depth of Seeded/Sodded Mulche <br /> Cell Center Cell Edges Topsoil [��Fes�❑No ❑No <br /> COMMENTS: (Include code discrepancies, persons present, etc.) Elevations taken with ¶/i)&4e. ZXAka.Q,wl <br /> i ' SCG iovaC( Cln.autt, -fa dra.ivSdoe ovt p(ofp(v., Filter ManufaMcturer:odel: tic d,- e. <br /> Electrician: / <br /> (Field directive given to plumber that all electric) . ,.•en necessary to be om.lete• by electrician per WI Admin Code.) 0 Ye io <br /> Plan revision required?❑Ye No 5 aOproviAld / /4Z/593 <br /> Use other side for additional information Date POWTS I rotor' Signature Certification Number <br />