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010-133-00-0100-SAN-2020-162
�6 )I �� v r . 1 ' �� ,� � � • � 1\ �r ��ku�" �;2. . �+ �� . a- (�tr� 2i• l rl S.3 S-� S �_3 �� . . n D� `� �7 `�, - �` � � .p � � � � � � � � --__,.._______ —� _, �"� \Y �� �_�r��n` � ��I,SP=-��'"�r /� i ��� ��� � - �V �� \ '���`'S/ � �\ � � ��� . ---�_ ----- -'�'""`"'�� PRIVATE ONSITE WASTE TREATMENT county =���s = SYSTEMS Sawyer ��t,� PS ( POWTS) ��....'q:f�-,--`. '"��'�'�;`� INSPECTION REPORT Sanitary Permit No: Safery 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#: '"\c�i V� � Z\`�c= �'�C- t�`� Insp BM Elev: BM escription: Parcel Tax No: ��� �v �o- � �r�\.� \,Z c`��\� �`�3-- �U -�\ao TANK IN ORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark ��; ��� � Dosing Aeration Bldg. Sewer Holding St I Ht Inlet TANK SETBACK INFORMATION St I Ht Outlet '�.\ TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet AIR INTAKE Septic NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. �j�-r � Holding Dist.Pipe � PUMP 1 SIPHON INFORMATION Inflltrative �3 9 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: SETBACK OHWM of Nav Conv ❑ Aggregate INFORMATION P I L Bldg Weli Waters o GP � Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound o Other ,�� �' .� _ _— __�--_ _ _- DISTRIBUTION SYSTEM X Pressure Systems Only [Header/Manifold Distribution Pipe(s) ' X Hole Size X Hote Observation Pipes ength _Dia Length Dia Spac ', Spacing O Yes ❑ No � SOIL COVER Depth Over Depth Over ', Depth of Seeded I Sodded Mulched Cell Center �ell Edges j Topsoil � ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) vc.-�`j e., �X �:��, �"I � ��,C� `� �.r�.k ,����.��.z� �/,�� �.�� Plan revision required?�Yes ❑ No I �' � � � �a� �� \`�` 3 1 aa� � ���.�— � -�- ✓ Use other side for additional information Date � POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AO�ITIONAL COMMENTS ANO SKETCH ' SANITAPY PERMIT NUMBER a�t7�-�V a � �� ��'�`� � ��� __ _ �� �,_ � . . , �. �-, ����� � ,_-, �`-7 � .�6#-F+1---_-_ . 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