HomeMy WebLinkAbout008-938-27-1201-SAN-2021-310 '"�'t`""'-"`�>; PRIVATE ONSITE WASTE TREATMENT County
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: � o$ SYSTEMS Sawyer
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�'���'�^-� ' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION oZ 1 � 3l D
Personal infonnation you provide may be used for secondary puiposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
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Insp BM Elev: BM Description: Parcel Tax No:
c�.�` N�� +- � a�, � �c. c�og- 53�-2�- f� 1
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic S �,✓ �00 Benchmark c7,S` pp.S' c�o,o�
Dosing
Aeration Bldg. Sewer r�,,v' qy,S �
Holding St/Ht Inlet 6,p$' � �
TANK SETBACK INFORMATION St/Ht Outlet 6.33' 4Y•l7'
TANK TO P/L WELL BLDG vENT ro ROAD Dt Inlet
AIRINTAKE
Septic 3�` ? j )� ` �..�� � NA Dt Bottom -
Dosing NA Installation '
Contour
Aeration NA Header/Man.
Holding Dist.Pipe
PUMP/51PHON INFORMATION Infiltrative
Surface
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W � #of Cells Type of System Distr�bution Media Manufacturer:
SETBACK OHWM of Nav Conv ❑ .Aggregate
INFORMATION P/L Bldg Well Waters � �GP ❑ Chamber Model Number:
❑ AG ❑ EZFIo
CELL TO ❑ Mound � Othe�,�,�/
DISTRIBUTION SYSTEM X Pressure Systems Only
Header I Manifoid Distribution Pipe(s) 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 Topsoii ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?�Yes❑ No I p3 �� �� �--�j_ —J �c� �� /
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
/ A�DITIONAL COMMENTS ANO SKETCH
/ ANITAAY PERMIT NUMBEA_ a i�.,3�___
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