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002-133-02-1202-SAN-2021-374 /j� '"'""'�``T PRIVATE ONSITE WASTE TREATMENT county ��� � "r�, (�;�sP$ l�; SYSTEMS Sawyer ( POWTS) \��—=�e�', `Z'='-"-"''='' INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION � I ,� 3'7 Y Peisonal 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#: �i� �F-��en Ya � S ��-- Ia^r�3-(o�.l o��33 � C_ Insp BM Elev: BM Description: Parcei Tax No: �O�.Z� � �o� ` o (' '�`p a'�1^N�-, j a02-�33 ^O,Z - ��.o� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic U,; �- 12�� Benchmark oo.o' Dosing �co.�-.bo �tt3o Aeration Bldg. Sewer q ,�l� Holding St/Ht Inlet �'�,�' TANK SETBACK INFORMATION St/Ht Outlet q7,2' TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet AIR INTAKE Septic ��S` �-a g` � NA Dt Bottom �l�,o� Dosing •� h .. „ NA Installation D�•6� Contour � Aeration NA Header/Man. Holding Dist. Pipe (0 3 .� PUMP 1 SIPHON INFORMATION Infiltrative � surface ����Y Manufacturer (� Demand Final Grade Model Number (S GPM TDH �p Lift Friction Loss Sys Head TDH Ft Forcemain L �� ` Dia �" Dist. To Well DISPERSAL CELL INFORMATION DIMENSIONS W (0� � 3�� #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ° Conv �, Aggregate INFORMATION P I L Bldg Well Waters °� GP � Chamber Model Number: ❑ EZFIow CELL TO �' �-(�� �tob �-�oo� Mound � Other - - -- —__ -------- ---- --- -- DISTRIBUTION SYSTEM X Pressure Systems Only Header I Manifoltl « Distribution Pipe(s) „ X Hole Size X Hole � Observation Pipes Length 3��3� Dia a Length �7� Dia ��S Spac 3��3 3��j� �� Spacing� �'es ❑No --------- ------- SOIL COVER --- _ __ - _ _ (-- __- — - ----- _ Depth Over « Depth Over � Depth of s� Seeded I Sodded ulched Cell Center �o�- l Cell Edges �a. Topsoil � �Yes ❑ No .L�Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) 12���-`�I���'I ��a���� =�'1�1� `' �6,,�,�1�� � `� ��' ���h� ���2-�.��.� = 5-r(� P� Plan revision required?�Yes❑ No � (�- �3 � �� �� � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITI�NAL COMMENTS AN� SKETCH SANITAAY PERMIT NIJMBEA: �I r�� _ ^�" � ^ ��� '� , . _ : : , - . _ _ . . , _. , , , • - . . , ! ' � ' � , , , , . ,__ ._ . __ . , . . . ; , -- -� - �__ ._- -,- _+- r �.- — - � - - • -- -�- - � -- ._ ._ --- � -. , . _ . �° �'�`c�' ' : ; � � ; . _ : . ___. _ _ � . ,.__. , . _ : . . .. ..___.. .;.... ._ ._.f .__... .. , . : ,p,t�'��?` - - - n � � � �*O' . . _ . � _ .:_ .__ . N� �a�►g'e _ : .� fi ` �� ����. �� �1.5` 3� 3� �eh� �� wi e�zc�� � �a�olg� �(���� �,��� � ��" � . . : ���-,s� ��-- SnJi r I„_ �� ��� i