HomeMy WebLinkAbout002-939-01-5212-SAN-2020-121 ;,:,.
'"'"'"``, PRIVATE ONSITE WASTE TREATMENT county •
= � �s - SYSTEMS Sawyer
-,� �s ( POWTS)
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'��������-` INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� ^ \�\
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#:
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Insp BM Elev: BM Description: Parcel Tax No:
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TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �1�t� �loy j Benchmark '�,'j'� �va_3
Dosing
Aeration Bidg. Sewer �S ��
Holding St/Ht Inlet �j s.�.s
TANK SETBACK INFORMATION St/Ht Outlet S vg
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIRINTAKE
Septic ��� (��- ��' � NA Dt Bottom �
Dosing NA Installation
Contour
Aeration NA Header I Man. 9'3.31
Holding Dist.Pipe
PUMP 1 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 � #of Cells Type of System Distribution Media Manufacturer:
�' Conv ❑ Aggregate �� , ,. �,�,
SETBACK OHWM of Nav �
INFORMATION P/L Bldg Well Waters � G ❑ Chamber Model Number:
❑ EZFIow
CELL TO �Q � '�j� (�a- �'s-1- ❑ Mound D� Other
DISTRIBUTION SYSTEM x Pressure Systems Only
— -- _ _ __ -
Header 1 Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes ,
Length Dia 1Length Dia Spac Spacing �Yes ❑No '
------ — -- - —
SOIL COVER
Depth Over Depth Over ', Depth of Seeded I Sodded Mulched
Cell Center � Cell Edges ' Topsoil 0 Yes ❑ No � ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?❑Yes O No , a, I�ax 1 aa I� ' /c..s�-�r - _J �a'�1�1�
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3I01)
� AO�ITIDNAL COMMENTS AN� SKETCH
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