HomeMy WebLinkAbout002-310-00-0800-SAN-2020-231 ,
"�"'"`� PRIVATE ONSITE WASTE TREATMENT co��ty
;l�aP$ ` SYSTEMS SaW er
�. � L— �, � ( POWTS) Y
" INSPEC�ION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO'PEF2MIT)
GENERAL INFORMATION ' ^ �, ^���
Persona(infonnation you provide may be used for secondary puiposes[Privacy Law,s. 15.04(l)(m) �«�
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
S� atc C�►do ASsDc, 4!K . . , . �� � � � .
Insp BM EI : BM Description: � .S!� Parcel Tax No:
���. o ` � d�' w�-I I c�o�- 310 - oo - o$�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER • CAPA�ITY STATION BS � HI FS ELEV
Septic � ;�.�.�,�,�-p(- 0 O Benchmark �{��s (dy Oy� /JJ.O'
Dosing �
Aeration Bidg. Sewer �
�,ls'
Holtling St/Ht Inlet � 1� ► 6�
TANK SETBACK INFORMATION St I Ht Outlet , ► s�
TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet �
AIR INTAKE
Septic �p r �,s� � {- )e� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man.
Holding Dist. Pipe
PUMP/SIPHON INFORMATION Infi�trative
Surface .?j5 � 9y�1�
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' L 7� � #of Cells � Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav �- Conv ❑ Aggregate �N.F
INFORMATION P�L Bldg Well Waters � IGP o Chamber Model Number:
❑ AG S�2 EZFIow
CELL TO � k� >r � _�-�pp� o Mound o Other �'� _ ,��o w
-- —
— _ -- - - __
--- -
ISTRIBUTION SYSTEM x Pressure Systems Only
Lengthr/Manifold Dfa _�Deng hution Pipe(s) Dia Spac ', X Hole Size Spa�ing ❑Yes at'❑ N'oeS I�I
SOIL COVER --
-- _ _ - — --- -- -- -
Depth Over i Depth Over ' Depth of Seeded/Sodded Mulched
Cell Center � Cell Edges Topsoil ___ � �Yes ❑ No ��Yes ❑ No�
COMMENTS: (Inciude code discrepancies, persons present,etc.)
� :�s�(Ic.J ro�q/ao �.n :t' � �3
�
� . _---- -- —�
� � -.
Plan revision required?❑Yes O No � I i � I a � �
�` 3 , .Sa- I/Loz�aws�i..,.� t �93 �s �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS ANO SKETCH
;a,;�Tqa, ��o,,,- v'�,,�qcQ �� • 'q�3 �
�fl��..�y �c,�Y �c
�o
. �s f..w._. �„c�„
�
� ?
�
�� 6p t,� `�,ao. �� . �i`.
r � ���.
� �Y �•
.
. _ 5'a`--- Q�, yn;��1}-��`
�, � ���0� �.�,�o � �
�. ,��o
C�� ,�'k.�s,
. �-Z �rbW
. Go nao
�6
G o�`�fl
��
, _ . .�. � ,
fi . .
N ��� �
� ti���
:. ��� � ��
S��►)�