HomeMy WebLinkAbout024-741-28-2101-SAN-2021-290 � ,'"T"`, PRIVATE ONSITE WASTE TREATMENT county
n��oS� ;', SYSTEMS Sawyer
,:;,,� s ( POWTS)
��`�'��=� ����� INSPECTION REPORT sanitary Permit rvo:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � 1 � ��'�
Personal infonnation you provide may bc used for secondary pu�poses[Privacy L.aw,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#:
s�-e�� r�tab�� ��d L�I,c�- �
Insp BM Elev: � BM Description: Parcel Tax No:
� �� .� �a,1 a-��1���, 36" � �. � s��..����'o4k oaY-��l -�-g-�co�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic ,,�,i •� ��0 Benchmark a ,�3 �),�3' �pp,��
Dosing
Aeration Bldg. Sewer ^
Holding St I Ht Inlet s; 3 ' �t 6.$3�
TANK SETBACK INFORMATION St I Ht Outlet ,6S � �„6,Y$�
TANK TO P/L WELL BLDG VENTTO ROAD Dt inlet
AIR INTAKE
Septic �-�op t �� ..��p` .{-�p� NA Dt Bottom -
Dosing NA Installation
Contour
Aeration NA Header/Man. "�,3S' °�'�,�$�
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative
Surface �'6� `���,3
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFOR ATION
DIMENSIONS �N '�� L t� #of Cells Type of System Distribution Media Manufacturer:
Conv ❑ aggregate �
SETBACK P I L Bldg Well OHWM of Nav o IGP Chamber
INFORMATION Waters � EZFIow Model Number: ,
❑ AG
CELL TO �F(oo .t gt� � ❑ Mound o Other Qy,F
DISTRIBUTION SYSTEM X Pressure Systems Oniy
----- - ----- —
Header I Manifold Distribution Pipe(s) X Hole Size I X Hole Observation Pipes
Length Dia Length _ Dia _ _ Spac_ � _ _ Spacing ❑Yes ❑ No
SOIL COVER
_— _— - —
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 ' , I
03 �3 ' �2 !- � -� -- _ 6� S� t �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITI�NAL COMMENTS AN� SKETCH
SANITARY PERMIT NUMBEA:__�1��0 _
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