002-940-04-3410-SAN-2021-376 -�;''"'"�^_-:; PRIVATE ONSITE WASTE TREATMENT �ounty
,,;;
%ki'i�aS l�;m'�, SYSTEMS Sawyer
�`��;,�� �s� '� ( POWTS)
�,,,H;f`�'-i,�,
INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (qTTACH TO PERMIT)
GENERAL INFORMATION Z., � ��
Personal infonnation you provide may be used for secondary pucposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#:
� L��.A C.C.C_ �,ss l�l�c� r—
Insp BM Elev: BM Description: Parcel Tax No:
�Jc�.c�� Ntir� d- cvb a.� 36"� Ss.�z �� 19��P� �o� _9Yt� -OY- 3YoS_
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �„ri�s�� ��Oao Benchmark I •3� 101,31 � oa•��
Dosing
Aeration Bidg. Sewer S'•�a.' ' Oq�
Holding St/Ht Inlet �•26' �} �O.OS�
TANK SETBACK INFORMATION St l Ht 0utlet �' S3 �, g'
TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet
AIR INTAKE
Septic ��` � � � -�-$ ' NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. S�3 } q'S S`��
Hoiding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative
Surface �•��� �l 3.�f
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 3 � $ .6$� #of Cells 2 Type of System Distribution Media Manufacturer:
Conv ❑ Aggregate T
SETBACK P/L Bldg Well OHWM of Nav � IGP �4. Chamber 'y`' � '
INFORMATION Waters � AG ❑ EZFIow Model Number:
CELL TO fi�(0 1� N N o Mound o Other �Y�
DISTRIBUTION SYSTEM X Pressure Systems Only
—_ - -----______-- - —
Header/Manifold Distribution Pipe(s) X Hole Size� Observation Pipes
Length Dia Length Dia __ _ Spac � _ � Spacing ❑Yes ❑ No
SOIL COVER
-- - - - --- -
Depth Over Depth Over i Depth of Seeded/Sodded � Mulched 1
Cell Center Cell Edges i Topsoil ❑Yes ❑ No ❑Yes ❑ No �
COMMENTS: (Include code discrepancies, persons present,etc.)
`� ��/� �((15/:7-c�.-I
��� ��— --
Plan revision required?❑ Yes❑ No l03 pc� a.� I (�t� � C'�c( JC� ��o
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITIONAL COMMENTS AN� SKETCH
SANITAPY PERMIT MJMBER'___ �L-- �7�0 _ _ C`�l'
�,b ��� �"�
q3���
��
�
� .
, �
� �,;� �,� �� �
�`��� ,�� T � ��`� .
� $ 6
. c�
� ,
�� N Q�.( _
: � �.r•
�d� � ��
�
�K�
�Ic� f
0
�� �-�'' �
�
5L�6F �"_