HomeMy WebLinkAbout012-284-00-1000-SAN-2020-049 - ``"""`� PRIVATE ONSITE WASTE TREATMENT co�nry
=���es � SYSTEMS , SaWyer
:�:� �$ � ( POWTS)
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zj���'"�-` INSPECTION REPORT Sanitary Permit No:
Safety and Buiidings Division (ATTACH TO PERMIT)
GENERAL INFORMATION I � ' Qy�
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(l)(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 ����� � Benchmark ��a `lo\.7
Dosing
Aeration Bldg. Sewer - ��,Sa
Holding St/Ht Inlet �'7.'3�
TANK SETBACK INFORMATION St I Ht Outlet �j"j, 17
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIRINTAKE
Septic NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header I Man.
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION �nfi�trative
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 ❑ Aygregate
INFORMATION P/L Bldg Well Waters o GP ❑ Chamber Model Number:
❑ EZFIow
CELL TO ❑ Mound o Other
DISTRIBUTION SYSTEM x Pressure Systems Onty
Hea�der/Manifold Dist9bution Pi e s p � X Hole Size '� X Hole Observation Pipes
� PO �
�en th Dia Len th Dia S ac Spacing ❑Yes ❑No
SOIL COVER
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�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 a ' a�1aa� �I __ , �'a� )'�1�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
��, AOOITIONAL COMMENTS ANO SKETCH
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