HomeMy WebLinkAbout002-940-29-4202-SAN-2021-322 ��t''"T"f�r,;; PRIVATE ONSITE WASTE TREATMENT County
;=;
�°��asp , ,, SYSTEMS SaWyer
`,�,1 s. �i ( POWTS)
��f=_=7��'
��''�+'w^='' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � I -- ���
Personal infonnation you provide may be used for secondary pucposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#:
S�-e,�� a- G,�o� e�- �-���,so� �S �Q� ,..._
Insp BM Elev: BM Description: �6�� _ ,�D e S*5- '� Parcel Tax No:
(c7o.c7� r
� �w1 c,�— do..�., br �a� �.� �z�e�eV, o�� � 9Yp _29_c.(,'Lp�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic , '� ���,�_ )',S�o Benchmark fj �p y'
Dosing �� �5�
Aeration Bidg. Sewer .
Holding St/Ht Inlet
TANK SETBACK INFORMATION St I Ht Outlet I•33�
TANK TO P/L WELL BLDG vENrro ROAD Dt Iniet
AIR INTAKE
Septic NA Dt Bottom �S, �
Dosing NA Instaliation
Contour
Aeration NA Header/Man. Y,� `
Holding Dist.Pipe
PUMP 1 SIPHON INFORMATION Infiltrative
Surface �•� �
Manufacturer Demand Final Grade �,� �
Model Number ],.S GPM u�� '��. 3 7 �
TDH� Lift Friction Loss Sys Head TDH Ft
Forcemain L +-6 S� Dia �" Dist.To Well
DISPERSAL CELL INFOR ATION
DIMENSIONS W � �j�( �(y� #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate ���I �
INFORMATION P/L Bldg Well N/aters Q GP � Chamber Model Number:
❑ EZFIow
❑ Other
CELL TO -�lcx� � foo �Co� ��_ ❑ Mound Q ,.�
-- - — ----- -
DISTRIBUTION SYSTEM x Pressure Systems Only
Header I Manifold Distribution Pipe(s) 1 X Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac _� Spacing ❑Yes ❑ No
— — ----- - — --------
SOIL COVER
Depth Over �epth Over Depth of � Seeded/Sodded � Mulched �
Cell Center Cell Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
��3I���ed (o(t c �1.�
%i� ' \ , ) • � Cp vl V . �� ati,`r 1
/
�
Plan revision required?❑Yes❑ No 03 07 a 2 ����
___1�� c�
.____� — -- _
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIONAL COMMENTS AN� SKETCH � �I�'"A
P IT I �R �� i 3�a o� I
SANITARY ERM NJMB� _ _ _ Q
�WN�
�
�
�'J
, �
. �. �� .
. a k bS
, Qy�
���
�. � � ���� C�� ���
ng� .�A i i i;e��S°
�'`�C `—�� � l�r.
�
I ���P
�
C� i
o�
Y
��.
��
� "� �,�
�63b% �d ���'�� .
S�CE I"=—