014-941-03-1305-SAN-2021-327 -=��=�""'-"���=>; PRIVATE ONSITE WASTE TREATMENT county
i�'i�p$ `l�; SYSTEMS Sawyer
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x"-�"��" INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2 t _ ��?
Personal information you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)J
Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
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Insp BM Elev: BM Description: Parcel Tax No:
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TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic p Benchmark �.�.' vZ,,�,� �po.a r
Dosing
Aeration Bidg. Sewer �7,7 ' �.s'
Holding St/Ht Inlet 7,�� ' q� 8'
TANK SETBACK INFORMATION St I Ht Outlet ,d;L' �g.l �
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic (v' } �` N N NA Dt Bottom '
Dosing NA Installation �,
Contour
Aeration NA Header/Man. �•a- � �a�
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative
t
Surface `�•� '�7�d'
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Weli
DISPERSAL CELL INFORMATION
DIMENSIONS W 3� � #of Cells Type of System Distribution Media Manufacturer:
Conv ❑ .Aggregate
SETBACK P/L Bldg Well OHWM of Nav � �GP � Chamber '
INFORMATION Waters � AG o EZFIow Model Number:
CELL TO (O � �/ o Mound o Other ��
DISTRIBUTION SYSTEM X Pressure Systems Only
— -— -- ------ —
Header/Manifold Distribution Pipe(s) ' X Hole Size , X Hole Observation Pipes
Len th Dia l Len th Dia S ac S acin ❑ Yes ❑ No
9 -- - 9 --- P -�-- __ I P 9 I
SOIL COVER __ __
Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center � Cell Edges Topsoil ❑Yes ❑ No 0 Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?�Yes 0 No ' �
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3I01)
A�DITIONAL C�MMENTS ANO SKETCH
SANITARY PERMIT NUMBER _____�1_-_��� ___
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