008-130-00-0700-SAN-2021-368 /i�T"E�%,,._ PRIVATE ONSITE WAS�E TREATMENT county
(`J��ogP �� SYSTEMS Sawyer
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INSPECTION REPORT sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � , _ ,3�,�
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#:
scb.f� Lo�`e ��wa�r �-
Insp BM Elev: BM Description: Parcel Tax No:
��o.z�� � R`I- roa� �C D�g-(3�-00 .p'7c��
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic wi�g.r�- (pu'c,� Benchmark 1•$3 [��,$3� �ob,o�
Dosing
Aeration Bldg. Sewer ?j.�? ' Q g.b3�
Holding St I Ht Inlet ,s� ��, 3�
TANK SETBACK INFORMATION St/HtOutlet 3, $3 � �tg,a �
TANK TO P/L WELL BLDG vENr To ROAD Dt Inlet
AIR INTAKE
Septic 7` �4-(00` -}-S� fi � NA Dt Bottom
Dosing NA Installation
Contour
� r
Aeration NA Header/Man. 5;,2 6
Holding Dist. Pipe
PUMP/SIPHON INFORMATION SurFace e b� `L� S:63 �
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 W � L�Qp� � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav Conv ❑ Aggregate ��� �
INFORMATION P I L Bldg Well Waters o IGP �Chamber Model Number:
❑ AG ❑ EZFIow
CELL TO r(-s -}-l 0 < <i-7 �-l00 ❑ Mound o Other �f f
- ----- - -- ---— --___
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac � Spacing ❑Yes ❑ No
_ _ . ._._---
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SOIL COVER
- — - --
� Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center I Cell Edges �psoil _ _ ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
���1(� �SI �61 a�
� _- --
Plan revision required?❑ Yes ❑ No O� �� �3 1 � � �R��� �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3I01)
A�OITIONAL COMMENTS AN� SKETCH
SANITAAY PERMIT NUMBEA; �2� -- 3 6�
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