HomeMy WebLinkAbout014-842-28-2106-SAN-2021-349 ��'''"T"�>�%, pRIVATE ONSITE WASTE TREATMENT County
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iy�"��o$ � SYSTEMS Sawyer
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��` �—�\� INSPECTION REPORT Sanitary Permit No:
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Safety and Buiidings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2 � - 3�{�
Peisonal infonnation you provide may be used for secondary purposes[Privacy L.aw,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
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Insp BM Elev: BM Description: Parcel Tax No:
1v�.�' b� ra � �t�r ���,..s- �36" �� ot�l— 8Y�-�8-2(06
TANK INF RMATI N ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,,,��Ssu- apo Benchmark ��S � �pp.y' �po.o �
Dosing
Aeration Bldg. Sewer , 2,S � 4S':2S
Holding St I Ht Iniet �;'? ' ��{,$�
TANK SETBACK INFORMATION St/Ht Outlet S.�i� ' 9 '
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic �� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. (,o ' 9 ,S �
Holding Dist. Pipe -
PUMP 1 SIPHON INFORMATION Surfacee ���� `�3�5�
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 2J � 6�(� #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav 9� Conv ❑ Aggregate I,�1
P/L Bldg Well ❑ IGP � Chamber `'�``
INFORMATION Waters � AG ❑ EZFIow Model Number:
CELL TO t 2, �_ ❑ Mound � Other ir'���—
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DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifoid Distribution Pipe(s) �'i X Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac �Spacing �Yes ❑No �
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SOIL COVER
Depth Over 1 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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Plan revision re uired?❑ Yes� No ��
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS ANO SKETCH
SANITARY PERMIT NUMBER ____�_���'___
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