HomeMy WebLinkAbout028-742-15-5101-SAN-2021-280 ��""' `� ; PRIVATE ONSITE WASTE TREATMENT County
�"��Sp `� SYSTEMS Sawyer
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INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2 l -�g0
Personal infonnation you provide may be 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:
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TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic W i� ��D Benchmark (vo.a`
Dosing t,,� i e.s.�- `? S�
Aeration Bldg. Sewer 76 4S�
Holding St 1 Ht Inlet 76,� '
TANK SETBACK INFORMATION St I Ht Outlet —j6,3 �
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet 0, '
AIR INTAKE 7 6
Septic k�� ��rj ` �ZS� �'�-�' NA Dt Bottom `b')•G S`
Instaliation �
Dosing h�5� ��5� '��-S\ h�..S� NA Contour
Aeration NA Header/Man. �S,S- r
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative c
Surface �Y�S
Manufacturer � � Demand Final Grade
Model Number G s GPM k� �°-)'• ��.0�
TDH� Lift Friction Loss Sys Head TDH Ft
Forcemain L �ga` Dia �...." Dist.To Well
DISPERSAL CELL INFOR ATION
DIMENSIONS �N � � S"D � #of Cells � Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters � IGP Cc Chamber Model Number:
❑ AG q�C EZFIow
CELL TO �}Lb� fi(pb� `�-foo -r-lob' ❑ Mound o Other
_ _-- __ -- --- ---- --- — ----- - -- _
DISTRIBUTION SYSTEM X Pressure Systems Only
Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac I Spacing ❑Yes ❑ No
— - --. _ -- — -- -- -- ---� —__- - --
SOIL COVER _
Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center �II Edges � Topsoil _ __ ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?❑Yes❑ No v��� � -. �, 6��'� �
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�DITIONAL COMMENTS ANO SKETCH
SANITARY PERMIT NUMBEfl ______�_I"�g�___
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