The URL can be used to link to this page

012-640-09-2108-SAN-2021-382 ��"'" `�.,� PRIVATE ONSITE WASTE TREATMENT �ounty /�� t" \�`�'� SYSTEMS ;� � n$ ,�� '�� Ps ( POWTS) Sawyer \\rSSi�'.-�/ INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �,1 -- �� 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#: �a�,-.,� �-4�aw n `-1'w�e-�2-� l��-c��-- — Insp BM Elev: BM Description: Parcel Tax No: coo .o � l��;l ��., l� " �a(,� 0��,-6`fo -o�i �a�o8 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEU Septic �,,r��- ( 6� Benchmark �, ` �o.?,S` op.D � Dosing Aeration Bldg. Sewer �'3,p ' q � � Holding St/Ht Inlet ,�,'7 ` ,�' TANK SETBACK INFORMATION St/Ht Outlet (,o ' q � TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet AIR INTAKE Septic .}�'� N � �S"� ��"� NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. l�•o� �, j� Holding Dist.Pipe PUMP 151PHON INFORMATION Infiltrative , � Surface �2•a �o.S Manufacturer Demand Final Grade Motlel Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFOR ATION DIMENSIONS W � � y #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate ��l� INFORMATION P I L Bldg Well Waters � GP ,� Chamber Model Number: ❑ EZFIow CELL TO �}-S �}-(p r.1 rl-�� ❑ Mound o Other _ Q Y fi -- - — — _ --- - - - --- DISTRIBUTION SYSTEM _ X Pressure Systems Only ---- - - - Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia �ength Dia Spac Spacing ❑Yes ❑ No - ---- — -. __--- ---- __—__� SOIL COVER _ __ __ -- - - -- — Depth Over Depth Over Depth of Seeded/Sodded Mulched Cell Center Cell Edges �Topsoil �D Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) ��s�� 8((� ��aa� — ----- — --1 � Plan revision required?❑Yes❑ No ^ b�� I� u� l�' '�- �j_--- Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3I01} AD�ITI�NAL COMMENTS ANO SKETCH SANITAAY PEAMIT NIJMBEA' oZ1_- �`�. ___ � G�,;`.�� , . , �� _ �� , - - ,�� `� � - � ��- , . - - - . 6� �-� . - , ��c , � — —. : _ . . �o , � : �, . _ ; , o, . _ , , -� f _ : _ _ ; �. � IS��(3�' , . . , _ , _ , : � ! � : . i. �k . ; ._ _.; .._ __� , _. ' , ,�^5� .� ,_ , . . _ ,_ .. '_ _„ ' ,�`�- � � fS� , ' ' ' ; l�l�,� �� . . _ _ . _ _ �P��' ` ._ _ �, _ . _ � �Q�`� 3 g��• �- -�- - s� ��r. �`�� . - � ��`�w � �6� w �,� V�ST�r� �T�- � H�y .---p,}- i� � „