HomeMy WebLinkAbout028-642-27-5506-SAN-2021-336 ��'t`''"'-""^'%; PRIVATE ONSITE WASTE TREATMENT county
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i>�'�s ������' SYSTEMS SaWyer
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INSPECTION REPORT Sanitary Permit No:
Safety and Bwldings Division (ATTACH TO PERMIT)
GENERAL INFORMATION o2 l � 33 b
Peisonal infonnation you provide may be used for secondary purposes[Pnvacy law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village I�Town of: State Plan Transaction ID#:
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Insp BM Elev: BM Description: Parcel Tax No:
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TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �j �eS.�— 000 pp Benchmark /, 3�� /o/.3 � o a.o'
Dosing
Aeration Bldg.Sewer —
Holding St/Ht Inlet � —
TANK SETBACK INFORMATION St I Ht outlet � �, $ ' 2$.S 3'
TANK TO P/L WELL BLDG A RNINTA�KE ROAD �� STT C� 3•6 g � ��6$�`
Septic �o� ��` �S �-S� NA �t�Batta+�S�'o T 3•B8 � �7,YS�
Dosing NA installation
Contour
Aeration NA Header/Man. 7.3 3� "��(.o�
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative 33, q 3`��
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 r L 6Y q ' #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate �,.� ,
P/L Bldg Well ❑ IGP Chamber Model Number:
INFORMATION Waters � AG � EZFIow
CELLTO �$ �� �75, ,E.�pp ❑ Mound o Other �y�
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DISTRIBUTION SYSTEM X Pressure Systems Oniy
Header I Manifold Distribution Pipe(s) X Hole Size � X Hole Observation Pipes
Length Dia Length Dia_ Spac ___�_ _ � Spacing ❑Yes ❑No
SOIL COVER
Depth Over Depth Over �Depth of Seeded/Sodded Mulched
_Cell Center Cell Ed es I Topsoil___ ❑Yes ❑ No �❑Yes ❑ No �
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?O Yes O No I �
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Use other side for additional information Date POWTS Inspector's Signature J Certification Number
SBD-6710(R.3/01)
ADOITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBEA ____�_.'�.3�o_
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