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030-178-00-0900-SAN-2021-378 �- �'` >,, PRIVATE ONSITE WAST'E TREATMENT county /;,>�..,_�,, ;\.� i�j � o$ ���; SYSTEMS �� Ps �-`' ( POWTS) Sawyer ���� ;:�. \��ss,"`i�/ INSPECTION REPORT sanitary Permit tvo: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION a l — 3�� Personal inYonnation you provide may be used tor secondary purposes[Privacy Law,s. 15.04(1)(m)J Permit Holder's Name: ❑City ❑ Village [�Town of: State Plan Transaction ID#: �Ce...�Zn d-1,�'�^-� �' '�.I,� we.�ar� — � Insp BM Elev: BM Description: Parcel Tax No: �Ah,c� � na�� �-��o�.� i�, la`' �� o3a- 1�8- oo- 6 Qo� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic � 1�� Benchmark 0,� � (po,�' (oo,o� Dosing b�� O ��y ' `t g r Aeration Bldg. Sewer 6•Y ` 4 3� � Holding St/Ht Inlet ,�` �3,62' TANK SETBACK INFORMATION St/Ht Outlet ;77 �13, 3' TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet AIRINTAKE Septic � 3�� $� �8 ' NA Dt Bottom Dosing NA Instaliation Contour Aeration NA Header/Man. Holding Dist. Pipe PUMP/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 W L #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ° Conv ❑ Aggregate INFORMATION P I L Bldg Well Waters � G ❑ Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound o Other ------- - --- —--- ----— DISTRIBUTION SYSTEM X Pressure Systems Oniy -- -- — Header/Manifoid Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia Length Dia Spac Spacing 0 Yes ❑ No ---- — SOIL COVER --- Depth Over �Depth Over Depth of � Seeded/Sodded � Mulched Celi Center Cell Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) � a� _ �� ) �s�l� oqla���-a � J J ��-6�ly p����'. / Plan revision required?�Yes � No � `� o� �s �..3 �____ ��., G�, � s�l� Use other side for atlditional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AO�ITtONAL COMMENTS ANO SKETCH SANITAAY PEAMIT NUMBEA'___�_�� __ G�� . ��� �� ' ; : . :_ . . : __ _ � . �_ _. : : _ , _ . . _ _ _. :_ _ _: __ _: _ :___---__�_ , - --- _ �-- - - - - --_. _-- - -- -_ __ . - --- � - , _ ,_ , : . ?. .. T _, � . ; . ! � � - - _: � _ ._ _._ ; , _ : , - �- - -- --- --- �� { � � ' : . . _ : . � � � + _ . _ _ � . . . _,. .__ . _ . ,._. .. ,_. _� , ____ _ __ : . � _ : , , , , . ._ � � �__._ ___ _ . _. _._, � �n q� � �o«� o� , �o �� ,,b� ;�,s���� P � ��,�.� � SK�,^` �� t— 8�--+ ` '�,(4rt. C ' � / / / / / � f —e.�,�}, � �� S�S� � � . �n ��-y ��� � / b���� �` r--, ! lb ��_ T��,�4�1;-}}- �► ,