HomeMy WebLinkAbout012-284-00-1100-SAN-2021-356 ����'`'"""��'- PRIVATE ONSITE WASTE TREATMENT county
,%�<�o �" SYSTEMS Sawyer
,\��Sp$ �,'"i
� ( POWTS)
�ka;;`--:;.Q=i
'=����^�'� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2 I � ��
Peisonal infonnatio�you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(in)J
Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
B�` �sl-► C�� K��-�-�r- ►�rs -ro��o�-�8y-c
Insp BM Elev: BM Description: Parcel Tax No:
�
�0�. 0 (�o w� Ccfh,� Nw ca�v.� C���., �� O\�� `�0—OD —(�c�0
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic e�u�,,� � �� � Benchmark /oo.o '
Dosing �,;e.�- -��
Aeration Bldg. Sewer -
Holding St I Ht Inlet -
TANK SETBACK INFORMATION St l Ht 0utlet �6,$9 �
TANK TO P/L WELL BLDG ARNNTA�KE ROAD Dt Inlet �Y,g'
Septic NA Dt Bottom 9 f, 5' �
Dosin ' ` ` ` NA Installation
9 �� � 's'-�S '�� Contour
Aeration NA Header/Man. 9 Y,c� �
Holding Dist.Pipe
PUMP/SIPHON INFORMATION Infiltrative a,3.a7�
Surface
Manufacturer C� b„� Demand Final Grade
Model Number �E3 GPM �{; �'S�67 �
TDH �j Lift Friction Loss Sys Head TDH Ft
Forcemain L ±- p Dia �" Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W 3 � �' � � ' #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv a Aggregate
P/L Bldg Well o IGP ❑ Chamber
INFORMATION Waters � AG y� EZFIow Model Number:
CELL TO .}�� �-� ' ,�-�' �� o Mound � Other
DISTRIBUTION SYSTEM X Pressure Systems Only
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 1
Cell Center Cell Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No �
COMMENTS: (Include code discrepancies, persons present,etc.)
=��a��e� 1� �3 l 2 l
��0�5 d25�����,r 1 �'• �'er��e�� p��s
����.�h�- ��s ���y.
�
Plan revision required?❑Yes❑ No I � '
0 3 ry a� _ � � G�' �l �o
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�DITIONAL COMMENTS ANO SKETCH
SANITARY PERMIT NUMBER:_�-_�_,�_.S�____
�� �0��2�
�b �
��-` �-°y� '��c
1
�
\�
���
i �.
�
X�
� �
'. ; i
C�.�' � �
' � e ,
• ?'�y�\` ��- �b��
\� � N���� �`f
�� !� ;� �,
, � w„� b�
�
y �
�
. �
` \ .,��� ��1J�'�"�ow 7���D
\�i
\'
�.�'�,
�
�
' - �
�l\a�'�
�
����
�.�"5�
�a
�p�---
s =