HomeMy WebLinkAbout010-162-00-0200-SAN-2020-218 '�'t""'-"'`� PRIVATE ONSITE WASTE TREATMENT county
���?��a ` SYSTEMS Sawyer
�'�:�,�� PS 'r' ( POWTS)
k ' �"' �`� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � � �
Personal infonnation you provide may bc 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:
10�::.�:,L; `-�C�� �`:..� ��e_: ��o�-- �:� �ic�=c=�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,,�;�.��� -�,� Benchmark �-j.�1r� lu`� `{�
Dosing
Aeration Bitlg. Sewer �'�; �
Holding St!Ht Inlet ��.��
TANK SETBACK INFORMATION St I Ht Outlet �j�_�.Q,
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic ��,�� , � ��' NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. �� �;3
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative
Surface �7
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 Well Waters o GP � Chamber Model Number:
EZFIow
CELL TO �� � " �.�; � n> A- �- ❑ Mound o Other
-- - - ____ _ - - -- ---- --
DISTRIBUTION SYSTEM X Pressure Systems only
Header I Manifold Distribution Pipe(s) X Hole Size � X Hole Observation Pipes
Length Dia l Length Dia Spac _� ' Spacing �Yes ❑ No �
-- — _—-- - - - — -- __.. �
SOIL COVER _ __
Depth Over Depth Over ' Depth of Seeded/Sodded Mulched
Cell Center � Cell Edges �, Topsoil _ ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?�Yes � No I '� : �\ �'�- � �
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS AN� SKETCH
SANITARY PERMIT NUMBER � �\�
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