HomeMy WebLinkAbout028-642-20-1404-SAN-2021-301 't'=""'"'�r� PRIVATE ONSITE WASTE TREATMENT county
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,;=(i o$P ��;T�'; SYSTEMS Sawyer
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��`�' ������' ' INSPECTION REPORT sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � 1 _3 p�
Pecsonal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(I)(m)]
Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
�'lavl � � `, iO�r- l.G� rw" �0$2�07-1��^ L
Insp BM Elev: BM Description: Parcel Tax No:
���•�' �c�.�.., Q�Co�r�e4t—� SwCan-a�s'\_ ��.bi�n ��0�6`72��^(YO
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic � ��p Benchmark .6' �p3,` / Qp,o '
Dosing �,�� 7�j
Aeration Bldg. Sewer
Holding St I Ht Inlet
TANK SETBACK INFORMATION St/Ht outlet S.?Q' 9?,8.2�
TANK TO P/L WELL BLDG AiRiNT°KE ROAD Dt Inlet ( ,( ` q7 0'
Septic NA Dt Bottom ,%� � �3.6S�
Dosing ��S` k�, t�5, �F-a� NA Installation
Contour
Aeration NA Header/Man. �, ( r (p�,S`
Holding Dist.Pipe
PUMP/SIPHON INFORMATION Infiltrative � i
Surface �6� �ao��(
Manufacturer ��N,, ',,� Demand Final Grade
Model Number �r GPM
TDH� Lift Friction Loss Sys Head TDH Ft
Forcemain L �3S-� Dia �.. � Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS �N �j L � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav ° Conv ❑ Aggregate
INFORMATION P I L Bldg Well Waters � IGP ❑ Chamber
❑ AG � EZFIow Model Number:
CELL TO •�S-� -Fj.-S ,� ` -+�' Mound o Other
�—---—
DISTRIBUTION SYSTEM X Pressure Systems Only
2' --f--- - —__— —
Header I Manifold ,� Distribution Pi e s _ �, — � ', X Hole Size � X Hole �,� ' Observation Pipes
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Length .o� Dia L Length�_ � Dia �S Spac �•o � a�c8g "_ � Spacing � �Yes ❑ N�
SOIL COVER
Depth Over Depth Over f � l Depth of - -- Seeded/Sodded T Mulched 1
Cell Center (�.�� �Cell Edges i2, � Topsoil � �� Yes ❑ No � [�Yes ❑ No �
COMMENTS: (Include code discrepancies, persons present,etc.)
r' -tis}�l(� � (�12 �
� I-f ,`�1'� —�j w�o..,��
Plan revision required?�Yes 0 No j b3 i �Y �� � ---G�� _ _ � �� � j�o
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS ANO SKETCH
SANITARY PERMIT NUMBEA__� (-30 �_____ '^L.(_ � -,_,
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