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010-841-25-5311-SAN-2021-335 "�'`'-"''"^�r:; PRIVATE ONSITE WASTE TREATMENT County ;�i'" � �, �$ ,��, SYSTEMS Sawyer ;x��, PS -� ( POWTS) h `—�.' "�^ INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION p2 � �- �3 y Personal infonnation you provide may be used for secondary purposes[Privacy L.aw,s. 15.04(1)(m)] Permit Hoider's Name: ❑City ❑ Village [�Town of: State Plan Transaction ID#: �a�-i� �l'JuSa�n �v�`\ �i,.��f"' Insp BM Elev: BM Description: Parcel Tax No: I d�,�' --� o� �s�-�� J�, �4`�', 032 -538 -oY- !y�� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark f'j,6 8� �oo.6 8` �oo,o ' Dosing , �AI� � S y � .4�, Aeration Bldg. Sewer Q Y ! � ��.$�8� Holding � 3 b� St I Ht Iniet 6 3 + ��( 3$r TANK SETBACK INFORMATION St/Ht Outlet 6.S�` 4y.� ' TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIRINTAKE Septic NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. Holding 3 ` � �� ] ' �-/� ' L� r Dist. Pipe PUMP I SIPHON INFORMATION Infiltrative Surface Manufacturer Demand Final Grade Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS �N L #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ❑ Conv ❑ Aggregate INFORMATION P I L Bidg Well Waters � iGP ❑ Chamber Model Number: ❑ AG ❑ EZFIow CELL TO ❑ Mound o Other DISTRIBUTION SYSTEM X Pressure Systems Only -- --- -- Header/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 Depth of Seeded/Sodded Mulched Cell Center �Cell Edges Topsoil __ ❑Yes ❑ No � ❑Yes ❑ N� COMMENTS: (Include code discrepancies,persons present,etc.) ��,s�� t�3��1 � u� ___ _� Plan revision required?�Yes O No i � I � �3 eB aa �__�� -� Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AODITI�NAL COMMENTS ANO SKETCH SANITARY PERMIT NUMBER: '�� _ �3 ��lT �--- ` �---- l.c.e L�,�ti� �--- �- � �,e�,l�C _ ��¢.�.� � � — — — _ � � �`�,(�lal p��; • �`Q�. ��'� � � � , Q��dn �,�- �� °� �opo � � ��(�. 4, „�.� *�oo` Q.M. ,� T � ,� ' I � � ��. "`"�� a� � � Q. � ��°�'� —�d--- -r� Ne�a�- 1'�. � r -��'�'�'"'�"'��,�, PRIVATE ONSITE WASTE TREATMENT co��ty �;I � , < •S �_ sYSTEnns Sawyer �� Ps ;,'' ( POWTS) �:��,�;;�,�r:';`�� INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �l - 33�" Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. I 5.04(1)(m)] Permit Holder's Name: ❑City ❑ Village [}�Town of: State Plan Transaction ID#: �-�q� ��, D �1��-�--�s fi �-�A K,a� Insp BM Elev: BM Description: Parcel Tax No: �c7�.�� e�b''�'1 c��.w 5� �Qn�4�f�� Ww. �� — ��^2'S- 5.3� � TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark �vo.o` Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St I Ht Outlet TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Septic NA Dt Bottom ��,3 3 ` Dosing NA Installation _ Contour Aeration NA Header I Man. ��1, 3Z` Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative Surface �oo.3�.` Manufacturer � Demand Final Grade �a�,�` Model Number �� GPM Ni � �Q-� �0 2,6;L� TDH ` Lift Friction Loss Sys Head TDH Ft Forcemain L�33 Q Dia �" Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS W ' � 7�` S, #of Cells a Type of System Distribution Media Manufacturer: (� Conv ❑ Aggregate �,,< < SETBACK P/L Bidg Well OHWM of Nav � IGP eq Chamber �� INFORMATION Waters � AG ❑ EZFIow Model Number: CELL TO .�.5-' �}-�oD` -4- o� _ .�-�p�p� ❑ Mound o Other Q,,�,� -- - --__ - - — __--- -- ----_ __ DISTRIBUTION SYSTEM X Pressure Systems Only Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia Length Dia Spac I _ _ Spacing ❑Yes ❑ No SOIL COVER �pth Over Depth Over I Depth of � Seeded/Sodded Mulched Cell Center Cell Edges � Topsoil ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) S�� .�� k�s��( �1��a� �— ,2 � 2° ��- �'� � s.�s d�� C) ��`s b-� Q�-��$ � �f 0 B _J ��, . � Plan revision required?�Yes❑ No I O 3 a ' � II �� ---- -- � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AO�ITI�NAL COMMENTS ANO SKETCH SANITARY PERMIT NUMBER: ,Z-� - 335� I ✓��L,.d� l,a�CfZ� D �� O �v I I � ��\�� ' �n�„e� � _ �o �\� .� �9 _�� o�yPo ��`��0 (n/ . � ��\� 7 � �� a � � � � � � \ _� � � , � � i U �� 3 , c;.' � QX,��ny �� , S/� � � ; - - Q�� CY) �. o�y, I� • ° �`a� . ` � ,� ( by �ww �—