HomeMy WebLinkAbout028-742-20-2201-SAN-2021-311 , � '"'' 'c; PRIVATE ONSITE WASTE TREATMENT co�nty
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�"��'-�'"'' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION o� � •�- 3(�
Personal inYonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village l�Town of: State Plan Transaction ID#:
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Insp BM Elev: BM Description: Parcel Tax No:
la�.c>' SW C.��l oT Cav�c, wd.��'� 152�—�Ya,-���0220)
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic w,�� du� Benchmark �.,^�S� (62aS� oo,o '
Dosing
Aeration Bldg. Sewer ZS';b' �
Holding St/Ht Inlet S( ` 57� �
TANK SETBACK INFORMATION St I Ht Outlet S-;a.(, ' R�.4q'
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic .�` +�S �}-l�' .�- o' NA Dt Bottom
Dosing NA Installation •
Contour
Aeration NA Header/Man. ,(,,7s � `�S S �
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative ���� yY�r
Surface �
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INF RMATION
DIMENSIONS W ' �3,2,� Yo` p' #of Cells S' Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav 1� Conv ❑ Aggregate �,� �
INFORMATION P I L Bidg Well Waters o G �Chamber Model Number:
❑ EZFIow
CELL TO t-�b� 1D .Ir-'�' � ❑ Mound o Other (�y�
- — - — ----- -- — —_ _--
DISTRIBUTION SYSTEM X Pressure Systems Only
Header I Manifold Distribution Pipe(s) I X Hole Size X Hole Observation Pipes
Length Dia �ength _ Dia _ Spac_ 1 _ Spacing ❑Yes_❑ No _
SOIL COVER
- -— - --
fDepth Over Depth Over �Depth of Seeded/Sodded 1 Mulched
Cell Center Cell Edges � Topsoil __ ___ ❑Yes ❑ No � 0 Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?❑Yes❑ No ��3 0-� a� IL -1���� �j� �� (�
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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 PEAMIT NUMBEA:____�_1=�J_�__.___
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