HomeMy WebLinkAbout002-940-05-1217-SAN-2021-303 �'�`'"'-`"'`�;,� PRIVATE ONSITE WASTE TREATMENT county
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\' '>'�"��`s�' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �. l _ 3 d3
Pecsonal 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#:
Je��nis d �rakc. 'P��S Q�rSs �'i�. --
Insp BM Elev: M Description: Parcel Tax No:
(OO.a Bo�w� Ga�e.r�po�c� N� ar+� Corr.As-- 00�-`�`��-dS- l a 1'7
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic yie�us- �oco Benchmark , 3 �p/,3' (op,�r
Dosing
Aeration Bldg. Sewer �,�3 � -�,o-�'
Holding St/Ht Inlet (� 3 ' �7,p,
TANK SETBACK INFORMATION St I Ht Outlet 1 f yg ` �(�,g�,
TANK TO P/L WELL BLDG VENT TO ROAD Dt Inlet
AIR INTAKE
Septic �.�o ��5� 1p� .�to` NA Dt Bottom
Dosing NA Installation _
Contour
Aeration NA Header I Man. S os- � ��,,�,�r
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative
Surface �.�` � `�$-2f c
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 ' � �`� (�Y #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate �`�� �
INFORMATION P/L Bldg Well Waters °� GP R� Chamber Model Number:
❑ EZFIow
CELL TO •4-�c� S' -}-�`p' ❑ Mound � Other �Y--
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DISTRIBUTION SYSTEM X Pressure Systems only
Header I Manifold Distribution Pipe(s) i X Hole Size 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 I Topsoil ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
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Plan revision required?0 Yes❑ No 'p3 Io�aai !,, - �j9 ��
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Use other side for additional informatio� Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITI�NAL C�MMENTS ANO SKETCH
SANITARY PERMIT NUMBEA:____��___�O�
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