010-839-01-5308-SAN-2021-302 -'"�'""T'"���r;_ PRIVATE ONSITE WASTE TREATMENT Cou�ty
'�,'i a$P ��;� SYSTEMS Sawyer
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��`"' ���' ? INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION p2 1 --.30a
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(l)(m)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
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Insp BM Elev: BM Description: Parcel Tax No:
(c�o.c�' �D.�-o,�,., b� s i��n� o�o - 839 - a( -S�.�o2�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic „„� — ��o Benchmark �,p� p ,�j �,� �
Dosing .-c��yo (,a�
Aeration Bldg. Sewer �. � � g� `
Holding St/Ht lnlet !fi,o ` q'�,p'
TANK SETBACK INFORMATION St I Ht Outlet t{.,1..5' q .7S`
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIRINTAKE
Septic f2S� fi�S ` ��� ,.�� � NA Dt Bottom 7.Y1 � 3,�$'
�,�_r
Dosing c. .. N �- NA Instaliation ,
Contour
Aeration NA Header/Man.
Holding Dist. Pipe ,p ' �$,a�
PUMP 1 SIPHON INFORMATION Infiitrative
Surface �l•.25� `��'�S`
Manufacturer �� �� Demand Final Grade
Model Number 3 GPM t � F�t• 2 � r �1 g S t
. ,
TDH 'S Lift Friction Loss Sys Head TDH Ft �3' .3•,?,$�� c� , '
Forcemain L �..�.. Dia " Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W . � � '�( ,� � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav
� Conv ❑ Aggregate �z,�q�
INFORMATION P I L Bldg We11 Waters � GP ❑ Chamber Model Number:
❑ EZFIow
CELL TO �a5" �' +�-p ,�.�► ❑ Mound fbC Other
- - ---- - - _----___. __ __ _
DISTRIBUTtON SYSTEM X Pressure Systems Only
Header I Manifold Distribution Pipe(s) ! X Hole Size X Hole Observation Pipes�
Length Dia Length Dia_ _ Spac i _ Spacing ❑Yes ❑ No
SOIL COVER
Depth Over Depth Over i Depth of Seecied/Sodded T Mulched 1
Cell Center Cell Edges � Topsoil ❑1'es ❑ No � ❑Yes ❑ No �
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?❑Yes❑ No �3 o�I 2a �� �7 1�- i �(�((P
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
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