HomeMy WebLinkAbout002-940-29-1106-SAN-2021-289 '"�'n0.'-"'�� PRIVATE ONSITE WASTE TREATMENT county
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{=�� BSP SYSTEMS Sawyer
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�k�'�"��' ����� INSPECTION REPORT sanitary Permit tvo:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � ( - a F�`�
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Vitlage Town of: State Plan Transaction ID#:
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insp BM Elev: BM Description: Parcel Tax No:
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(�.� �vp o� s�T= c�t-�r �� oo�.- qY0- �`t-lIOG
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic (�° Benchmark I�•o �
Dosing v�,; .�r -7 Sf�
Aeration Bldg. Sewer —
Holding St I Ht Inlet —
TANK SETBACK INFORMATION St I Ht Out�et �j�,-� '
TANKTO P/L WELL BLDG AIR�NTA�KE ROAD Dtinlet ��,bY'
Septic NA Dt Bottom g�(6 �
Dosin � � ` ` NA Instaliation �
9 '� '�"�°� �p° '��«' Contour l�(•3
Aeration NA Header/Man.
Holding Dist. Pipe (o�.3Y
PUMP 1 SIPHON INFORMATION Infi�trative ,
Surface l�7?
Manufacturer Demand Final Grade
Model Number �q GPM
TDH t3 Lift Friction loss Sys Head TDH Ft .
Forcemain L �S'` Dia " Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W 3,as' � S #of Cells Type of System Distribution Media Manufacturer.
SETBACK OHWM of Nav ° Conv ❑ Aggregate �ep�q-�—
INFORMATION P I L Bldg Well Waters °� G ❑ Chamber Model Number:
❑ EZFIow
CELL TO �` �-�op�_ �do' �. � Mound � Other
--- --_. -- — - - -- - _-- -— ---- ---
DISTRIBUTION SYSTEM X Pressure Systems Only
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Header!Manifold Distribution Pi g(s) „ X Hole Size�a X Hole r Observation Pipes
Length � Dia�. _ Lengt 3. Dia � Spac " �o,l8$ i Spacing � �Yes ❑ No
-- -—.. _- — ---_
SOIL COVER `—
Depth Over « Depth Over ci Depth of / �, Seeded I Sodded Mulched
Cell Center � � 1 Cell Edges �� Topsoil D __ �es ❑ No l �Yes ❑ No 1
COMMENTS: (Include code discrepancies, persons present, etc.)
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� P-r. �-���� 6�1y
Plan revision required?�Yes ❑ No '�p 3 ' �3�`a �I - _ � 6q�f �
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AODITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBEA:___.��—���_
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