HomeMy WebLinkAbout018-837-09-2301-SAN-2021-326 ��7�`' � `` PRIVATE ONSITE WASTE TREATMENT county
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INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �, l r 3��
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)j
Permit Holder's Name: ❑City ❑ Village I�Town of: State Plan Transaction ID#:
hk �-'Sd�e_ ��.�.� IMe.�'ea-�'
Insp BM Elev: BM Description: Parcel Tax No:
�•c�` Nq,t fibb��, 3b"� �,r}-.n-�. l 6" �Qk o18-83?-0� - 23a �
TANK INF RMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic W�e,�r- �pp� Benchmark �,'"� ` �oa.") ` (oo,o'
Dosing
Aeration Bldg. Sewer ?
Holding St/Ht Inlet �,5"7 ' q fo. �
TANK SETBACK INFORMATION St/Ht outlet (�•7 S`' `�S.9S�
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIRINTAKE
Septic }�� ��S` ��„ ` NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. 7, ( � ��� 6 '
Holding Dist.Pipe
PUMP 151PHON INFORMATION Infiltrative �� � Qy� �
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 �N 3 L ' �j' #of Cells,3 Type of System Distribution Media Manufacturer'
SETBACK OHWM of Nav Conv ❑ Aggregate
INFORMATION P(L Bldg Well Waters °` G ❑ Chamber Model Number:
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CELL TO ��` '��1�` N ❑ Mound � Other
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DISTRIBUTION SYSTEM x Pressure Systems Only
Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia Length _ Dia _ Spac L Spacing ❑Yes ❑ No�
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.)
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Pian revision required?�Yes ❑ No � ��j ��
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Use other side for atlditional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
ADOITIONAL C�MMENTS AN� SKETCH
SANITAAY PERMIT NIJMBEA: �) � 3a�
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