HomeMy WebLinkAbout020-638-10-4301-SAN-2020-134 -'�'''""'�`� PRIVATE ONSITE WASTE TREATMENT co�nty '
=���es _ SYSTEMS Sawyer
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�'����^�'`" INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION a� ' �-3y
Personal info�nation you provide may be used for secondary purposes[Privacy Law,s. (5.04(I)(m)] �
Permit Holder's Name: ❑City ❑ Viilage Town of: State Plan Transaction ID#:
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Insp BM Elev: BM Description: Parcel Tax No:
lor�. o c� �o �• ��: '.c� v2�c�-�038 --lp-�-('� �
TANK IN ORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,J;z�, gsv S� Benchmark .'� �o�.7S
Dosing
Aeration Bldg. Sewer �`a.1 S
Holding St/Ht Inlet ��,a,s
TANK SETBACK INFORMATION St I Ht Outlet ��S
TANK TO P/L WELL BLDG vEr,T ro ROAD Dt Inlet
AIR INTAKE
Septic N � 3'3 k NA ��,�� Dt Bottom Cj\ .�3
Dosing NA Installation
Contour
Aeration NA Header 1 Man.
Holding Dist.Pipe
PUMP/SIPHON INFORMATION Infiltrative �
Surface
Manufacturer (_��_,� - Demand Final Grade
Model Number -�;5 GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W L #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav ° Conv �( Aggregate
P/L Bldg Well ❑ IGP o Chamber Model Number:
INFORMATION Waters ❑ EZFIow
❑ AG
CELL TO ���� �J ' -�- ^, � ' � Mound o Other
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distribution Pipe(s) �X Hole Size � X Hole Observation Pipes ;
Length Dia Length Dia Spac I Spacing �Yes ❑ No J
---- -
_ ----
SOIL COVER
-- -- _ _ __--
Depth Over Depth Over ', Depth of Seeded/Sodded Mulched
Cell Center � Cell Edges ' Topsoil __ ❑Yes ❑ No �❑Yes 0 No 1
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?�Yes ❑ No 3 _� �a�-�, II _ ��,Q 1,� ��
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
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