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Home My WebLink About002-940-04-1223-SAN-2021-024 _ i �.� � : - ,-�� ` ` -�� . �` c ,�°� ,e��.� � • I � � � �� ,. , �� ,� o ' ..r---�--�""��J I c�� F � , � � 1 P^ �� g�i�' �� . � ,{ d • I �I i i � I .�� , � �« ��--.-�-3 � � ► � ,� � �'� � � � , ', t 11i _ - ; � �'; � � �_.,.--� � c i �� _. _ _� ___--�-� '�;t'`�"'"��; PRIVATE ONSITE WASTE TREATMENT co��ty �� 7'��Sp �� SYSTEMS Sa,Wyer s � ' ( POWTS) ;,,. : ��```'"��^��'`�� INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �` � �.�� Pecsonal infonnation you provide may bc used for sccondary purposes[Privacy L�w,s. 15.04(1)(m)] � Permit Holder's Name: ❑City ❑ Village '� Town of: State Plan Transaction ID#: �� +��\-e: �-�:_��: �_�'� �Y Insp BM Elev: BM Description: Parcel Tax No: � � �v�:.�� V�v��. �-� --.�� G� ��_ VU�---��U -C�`� —' �o��—� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �� Benchmark �,_�;'� 1 � Dosing Aeration Bldg. Sewer -� a`� Holding St I Ht Inlet �j�,_�� TANK SETBACK INFORMATION St/Ht Outlet (�.S`7 TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIRINTAKE Septic 3;,�. -- �� k NA Dt Bottom Dosing NA tnstallation Contour Aeration NA Header/Man. �,;(� �� Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative Surface `��•�f S 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 Distrlbution Media Manufacturer. SETBACK OHWM of Nav � Conv ❑ Aggregate INFORMATION P I L Bldg Well Waters °� G � Chamber Model Number: o EZFIow CELL TO �� \J' — o Mound o Other ��` �I ----- - - - --__ __. _ --— - DISTRIBUTION SYSTEM X Pressure Systems Only - -- T- Header/Manifoid Distribution Pipe(s) X Hole Size X Hole Observation Pipes i Length Dia_ Length Dia Spac ; Spacing ❑Yes ❑ No _� --__ -- - ---__ SOIL COVER — - . _ . Depth Over Depth Over Depth of Seeded I Sodded Mulched Cell Center �Cell Edges � Topsoil ___ ❑Yes � No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) `7,,��,�-- -.�-.��\�� o�i'3 � ��\ � Plan revision required?�Yes 0 No � '� ,--� ;�'� i L�� -- ---I �� ? 1 � - - �� — � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AO�ITI�NAL COMMENTS AN� SKETCH SANITARY PERMIT NUMBER: ��-v�'�__-_--- . , , ,_ � -.. _ , . :_ ...__. .� __. ._ _,,_- �-- . _ � _ ..,_.._.,_ _, ; _ ., _ _, _ . , , ; , , _.. ,___._ . __. , , ; �_ , .�__ -�-.-. �._ , � � ;, ! ' �. _ f......_... ;...._. :._ � : , _.... ._.+. ; , , , _._. . , ._ ,_ . __., - , _ . �_ <. _:..__ , : : _..__. � ; . i + ` �;�� -�1 � , --- , ,r�'• , ' `L � i .� N � — � o � I y ! `i -� �. �� ,� � ;� �� `��✓ .�� ,, �'� ?J\'� ��`J � �`��/ � c,^ � J L� � ,��