HomeMy WebLinkAbout002-940-13-5510-SAN-2021-348 "��'""'"E�>; PRIVATE ONSITE WASTE TREATMENT county
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=�'��aS ,��;�' SYSTEMS Sawyer
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°""�"y�';`" INSPECTION REPORT sanitary Permit rvo:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �' � 3 �g
Personal infonnation you provide may be used for secondary pu�poses[Privacy L.aw,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 �,,,`� �� Benchmark D,�S� (oa��-S� •a�
Dosing
Aeration Bldg. Sewer �,3` q�,�S�
Holding St I Ht Inlet 7,'� � ���
TANK SETBACK INFORMATION St I Ht Outlet 7,95' �. '
TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet
AIRINTAKE
Septic :��j' N N N NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. g•lS� `�,�,( '
Holding Dist. Pipe
PUMP/SIPHON INFORMATION Infi�trative � �
Surface `�.(S °� ( , I
Manufacturer Demand Final Grade
Modei Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W � � (� 6 #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate �-�I�
INFORMATION P I L Bldg Weli Waters o GP 6� Chamber Model Number:
o EZFIow
� i � ❑ Other
CELL TO ��p � �� _ ❑ Mound Qy�
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DISTRIBUTION SYSTEM x Pressure Systems Only
Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes i
Length Dia _I Length _ Dia Spac � Spacing ❑Yes ❑ No �
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SOIL COVER
Depth Over Depth Over �epth of Seeded/Sodded Mulched
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 ��a.� � � � _� �j`3 � � �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITIONAL COMMENTS AN� SKETCH
SANITARY PERMIT NUMBEA: 2.�_- 3�__
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