HomeMy WebLinkAbout002-145-22-0300-SAN-2021-317 ;;<�t`J'-aT"``�;. PRIVATE ONSITE WASTE TREATMENT county
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''`'"�'�`'�' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION a� �3��
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(in)]
Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
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Insp BM Elev: BM Description: Parcel Tax No:
l�•� N F c�<.,.�r- -� ��s- �o �� 'n.t,�,� ob 2-(uS`—�2-b,3o 0
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic w�-e.S-�— , U� 0 Benchmark o.c>` lcO,b� ('oa.o'
Dosing
Aeration Bldg. Sewer
.8�' 9 s�a'
Holding St/Ht Inlet g���-� y l,$$'
TANK SETBACK INFORMATION St I Ht Outlet �,3�� �(, 7'
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIRINTAKE
Septic ,}�p� fi�� �F�S� .}.�$� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. �3,� � $(.3Y'
Holding Dist. Pipe .
PUMP 1 SIPHON INFORMATION �nfiltrative •
Surface
Manufacturer Demand Final Grade
Model Number GPM � I�.b6 � �S.3 �
TDH Lift Friction Loss Sys Head TDH Ft ( ,2S' -� �
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W 3� � (�Y 6 Y #of Celis Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv a Aggregate �I �
INFORMATION P I L Bldg Well Waters °� GP 6� Chamber Model Number:
❑ EZFIow
CELL TO j'2,�� ` �'$e (�t _ ❑ Mound ❑_Other �y,�
DISTRIBUTION SYSTEM x Pressure Systems Only
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Header 1 Manifold Distribution Pipe(s) i X Hole Size X Hole Observation Pipes !
Length Dia �Length Dia Spac i __ _ Spacing ❑Yes ❑ No�
SOIL COVER _ —
Depth Over Depth Over T Depth of Seeded/Sodded I Mulched l
Cell Center Cell Edges Topsoil _ ❑Yes ❑ No � ❑Yes ❑ No �
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?0 Yes� No I b3 j o� a 2 � � _ � G�f �1�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITIONAL COMMENTS ANO SKETCH
SANITARY PERMIT NUMBER:_____�_��'�_______
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