HomeMy WebLinkAbout002-940-02-2101-SAN-2021-320 '""'''""'-"``:r PRIVATE ONSITE WASTE TREATMENT county
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� i'%$PS �'� SYSTEMS Sawyer
( POWTS)
\A F'�`.lil.�n�.�s��v`/,
INSPECTION REPORT sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � ' _� ��
Personal inYonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village [�Town of: State Plan Transaction ID#:
3�.-�- �w�e.�5o�. 1B�rs (�,I,c�_ �
Insp BM Elev: BM Description: Parcel Tax No:
�C.�.c7� �6'�'Ov�n C�t,.��, � �'�,,`1 �'� 5��� ���..�YC`� --�a� a�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,,,� .. d� Benchmark —( ,�$� ,'7.S� �oa.�`
Dosing .- �o,..,Vjb (,ap l.�
Aeration Bldg. Sewer --
Holding St/Ht Inlet 7•�S ` 0. �
TANK SETBACK INFORMATION St/Ht Outlet ��I S ' o.6 �
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic �(�o` �,�5` �` .}�,�� NA Dt Bottom � I.3 � . ?.�(S�
Dosing �•
" °' �� NA Installation
Contour
Aeration NA Header/Man. 6_d � �2,75-'
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative
i ,
Surface 7.0 �.'�S'
Manufacturer L, Demand Final Grade
Model Number ��. � GPM �{� l,� `�'�', �4�� q 3.$3�
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L �-K-p� Dia �..`� Dist.To Well
DISPERSAL CELL INFO ATION
DIMENSIONS W � L b Y #of Cells Type of System Distribution Media Manufacturer:
Conv ❑ Aggregate
SETBACK P�L Bldg Well OHWM of Nav � �GP � Chamber � �
INFORMATION Waters � AG ❑ EZFIow Model Number:
CELL TO �}-(oD � � �gS� N a Mound a Other — ��
DISTRIBUTION SYSTEM X Pressure Systems Only
Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes '�
Length Dia Length Dia _ Spac 1 _ Spacing ❑Yes ❑ No _ J
SOIL COVER
Depth Over Depth Over Depth of Seeded/Sodded � Mulched
Cell Center Cell Edges Topsoil _ _ _ �Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
�-�-,.s}a I(�J l b�06 ���
� _____-- _ _ �
Plan revision required?�Yes� No �� �
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Use other side for additionai information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIONAL COMMENTS ANO SKETCH
SANITAflY PERMIT NUMBEA: `oL1 ^ 3��
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