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006-439-04-2104-SAN-2021-251 ����;�-T�"� PRIVATE ONSITE WASTE TREATMENT county �,�,�� , � �� SYSTEMS i��' °S '�J Saw ��'��F=�/ ( POWTS) yer \�=ss��=r,.i INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION a � � �5--� Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)) Permit Holder's Name: ❑City ❑ Village (!�Town of: State Plan Transaction ID#� �+ya-- Lo:s ���re��� �ra ��-0�.21 D("73b-�— Insp BM Elev: BM Description: Parcel Tax No: ��.�� l�I,�j i�'� I h �s�� cYf'(S u �� Yi�w- O(i�c~ ��'-O�(-�1�� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic — 7� Benchmark ,S' o�,S� !o�•�� Dosing �,,�,.1� �p Aeration Bldg. Sewer (fl.S' 9 p� Holding St/Ht Inlet p '78 r 72, TANK SETBACK INFORMATION St/Ht outlet o3< < TANK TO P/L WELL BLDG vENr To ROAD Dt Inlet AIR INTAKE Septic -►-�o` �1-$0' .j.�p` �p� NA Dt Bottom ( �,,..� ��3' Dosing H � a n NA Installation Contour Aeration NA Header/Man. �O 3 � �`��y�� Hoitling Dist.Pipe PUMP 1 SIPHON INFORMATION Infiltrative 3,(�S c �g g�'` Surface � Manufacturer Demand Final Grade Model Number QF � GPM TDH � � Lift Friction Loss Sys Head TDH Ft Forcemain L �-.,�' Dia `' Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS W(,,(07 � #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ° Conv � Aggregate INFORMATION P I L Bldg Well Waters o GP ❑ Chamber Model Number: ❑ EZFIow CELL TO �-�' � 'S i�o �-foD �Mound � Other DISTRIBUTION SYSTEM X Pressure Systems Only Header(M nifol� � Distribution Pipe�(s) �t � X Hole Size X Hole2 2c� Observation Pipes Length 3�y Dia �•�-S � Length�'.�! Dia >>2S _Spac� p� � Spacirig _ es ❑ No _ SOIL COVER � - - - - — -- Depth Over << Depth Over �i Depth of �� eeded I Sodded Mulched Cell Center �� Tell Edges �- Topsoil d �Yes ❑ No C�Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) yk�,s}�/� 6�( ��da� Plan revision required?�Yes � No i O 2 pg �3 �� _ � Gq��b � -- Use other side for atlditional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITtONAL COMMENTS ANO SKETCH SANITARY PEAMIT NUMBEA: � 1 _��I _ � (.�-� 1.91,��-- , : : . : , : _ _ , � _..._L.._._� .. ._�i._.__ :.._.....__.__.F_. t._ ...... ..'. ."_.: ... .�...'_ i.._ :.''_ ' . .. � . _ __' ' _'_. .__r...._ '_ __ . _... __... ... ._. _ _._ .� ..._, . . . , . . , . . . ' I .._... . . . . ... _... . _. . .t .-. . �. . ... � . . ._.. ._.. . .. . _ . ..._ .. .. . . . .___.. . ., ( � � i i ,i . .._ .. . _ ._.. ._ . . .,. , _ {-.. �.. _ .. . .� . �: . ., . � �. _i-__ '_ "'_ . '_"_ �i I � � i ��r5„fl � � ; ._ , . . __ _ . . ; _ _; : --- -- . ' �' ' ��°�� ��� ' 6�.Y I , �' 1 �. �� � �— — �J %• a � �-60' g`''— � �-�. o � 3 � C � . �' '�\ �'��IL ��3 �� �,-�e.S�"°'�, �� . `��