HomeMy WebLinkAbout010-941-21-2115-SAN-2020-166 ' '-"'f� PRIVATE ONSITE WASTE TREATMENT county
„
! SYSTE M S
�v 1SP$ ' � ( POWTS) Sawyer
��. ,,
\��`---�p� .
�F'��'��`� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
s
GENERAL INFORMATION ��� I b 6
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. i 5.04(1)(m)]
Permit Hoider's Name: ❑City ❑ Village own of: State Plan Transaction ID#:
�J�c� � A I� �Son �t'IC ��. W a.rc� ,
Insp BM Elev: BM Description: Parcel Tax No:
oo .�` -1-0 � o� ro�*�'t- �� :P� 010 - 9 � -� - a��5
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic ;F, (- Zj�O Benchmark ,9G o 3.q b (oo.o'
Dosing
Aeration Bldg. Sewer W� (p
Holding St/Ht Inlet p$
TANK SETBACK INFORMATION St I Ht Outlet � 3
TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet
AIR WTAKE
Septic ' � � ;- �p� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header I Man.
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative
Surface � • OS 9 �9�
Manufacturer Demand Final Grade °
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain � Dia Dist.To Well
DISPERSAL CELL INFORMATION -
DIMENSIONS W � � ' � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate �N �
INFORMATION P/L Bldg Well Waters � G „�Chamber Model Number:
❑ EZFIow
CELL T0 , q� .} /5� /�/A (� p► . ❑ Mound o Other ���� �, _ C�
DISTRIBUTION SYSTEM x Pressure Systems Only
Header I Manifoid Distribution Pipe(s) �T TX Hole Size X Hole Observation Pipes
Length Dia Length � Dia Spac � � i Spacing ❑Yes ❑ No
_-- ---- T ----- � .
-- ---
SOIL COVER
� _--- - _ --_---- P ___— —
De th Over De th Over De th of - Seeded!Sodded Mulched
Cell Center � � Cel�l Edges Topsoil___—T ❑Yes ❑ No T 0 Yes ❑ No
COMMENTS: (Include code discrepancies,persons present,etc.)
� (/�3�11�d (O� 7/� • .
,
;,
,4
.v
Plan revision re uired?❑Yes � No � �
I�� � �-oZ�a4SLC o � � Sq
q 1 � �— �
���_� �-----�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
, A��ITI�NAL COMMENTS AN� SKETCH
saN�rnPv P�Rti+�r Nuti�e=F �t�-_�-�_
�
� �° �`t �� ,
a
��'v�'� J�`�
����'~`
;t� y` ��. QN��u t
� ��`�� �l•s 1'�;'r`
\:�X`' cIo v�fs bb��
i .. P•P• / 3 . .�5�
�� � a � � -
� a , ' _9'_
3' 3 ' q, �1�)
Ztr� c1L �
V�'T 1�� t� P��
�' +.pl� �
� � y �
� �D�� C��.�SQ-
�_� �ro�s�
��:.A�_, ��-