HomeMy WebLinkAbout028-742-33-5302-SAN-2021-298 �'��`'""""�%>, PRIVATE ONSITE WASTE TREATMENT county
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' �"�'' ' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � I �'�
Personal infonnation you provide may be used for secondary pu�poses[Privacy Law,s. 15.04(1)(m)]
Permit Hoider's Name: ❑City ❑ Village ❑ Town of: State Plan Transaction ID#:
J`-t,SG �G�("`�'� li. J 1'�,S �--
Insp BM Elev: BM D scription: Parcel Tax No:
c�0.a� c�r�cr co•.,c.S1��o a��► :�, a'� o�� —7�(�.• 33'�.3t��.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic � •,,� Benchmark S'', ,2` ps ` pn.b�
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION Stl Ht Outlet oy' q�8,16 �
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
Dosing NA Installation `.
Contour
Aeration NA Header/Man. p,�� �S;p'
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative
Surface 11 •2� q'Y•7�
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFOR ATI N
DIMENSIONS W ,3 � �j0` � ` #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate � r �
INFORMATION P/L Bldg Weil Waters o GP 3� Chamber Model Number:
❑ EZFIow
CELL TO .}� � �'�-s" ,}� .� � ❑ Mound o Other (�Y�
-- - — -_ � --- - - — — --
DISTRIBUTION SYS EM X Pressure Systems Only
_ - -- —
Header I Manifold Distnbution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac I� _ Spacing ❑Yes ❑ No
SOIL COVER
-- --
Depth Over �epth 9ver � Depth of Seeded/Sodded Mulched
Cell Center Cell Ed es � Topsoil _ _ ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?�Yes❑ No b3 �3 � '� � �cl � , `�
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIONAL COMMENTS ANO SKETCH
SANITAAY PEAMIT NUMBER: v���_
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