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HomeMy WebLinkAbout028-742-30-1105-SAN-2021-383 %�'"'`'�`-"�"�:� PRIVATE ONSITE WASTE TREATMENT co�nty /�'�' �A. �,�?�o$ \`,;,'� SYSTEMS SaW er ,��'��Pi% ( POWTS) Y k�"F'��'"��=' INSPECTION REPORT sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION oL � ` 3�3 Personal infonnarion you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village �Town of: State Pian Transaction ID#: �1r4► �°lvt,1 � ��1�ir� �C��I� � 1�Q,T— �t� �� Insp BM Elev: BM Description: Parcel Tax No: �oo.�� N .� ���.� 5��� ��- ��..��-- oa�-�Y�-3o-�c�� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic w; Q�� �?� Benchmark �..J �,1,6 � ��,1,6 ' �dz>,a� Dosing Aeration Bidg. Sewer �as� q�,� � Holding St/Ht Inlet �� � g , � TANK SETBACK INFORMATION St/Ht Outlet g.�(, ' q , � TANK TO P/L WELL BLDG VENT TO ROAD Dt iniet AIR INTAKE Septic .}�b� yY ` IoL a-�'�- � NA Dt Bottom Dosin NA Instaliation �{.SS —� r 9 Contour �•�S `��a� Aeration NA Header/Man. ��S ' �{6• � Holding Dist.Pipe PUMP 1 SIPHON INFORMATION Surface e ��'O� r `�� � � 9 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 W 3 L �p p` #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate INFORMATION P�L Bldg Well Waters � IGP ❑ Chamber Model Number: ❑ AG D� EZFIow CELL TO �"�{a` ¢ t (�'7 /lJ o Mound o Other — ---__ --- _-- DISTRIBUTION SYSTEM X Pressure Systems Only --- — Header/Manifold �Distribution Pipe(s) X Hole Size X Hole Observation Pipe� Length Dia Length Dia Spac Spacing ❑Yes ❑ No - - - — - -- SOIL COVER __—_ _--- — --- - -- _ -- Depth Over Depth Over Depth of Seeded/Sodded Mulched Cell Center Cell Edges �Topsoil �— ❑Yes ❑ No � ❑Yes ❑ N� COMMENTS: (Include code discrepancies, persons present,etc.) ��,s�l(� ��8��� Plan revision required?❑ Yes❑ No d2 �5-- �� � — Gcj� /� � �� � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITIONAL COMMENTS AND SKETCH SANITAAY PEAMIT NlJMBER: �-�-`�3 �I� \ �o ri.��..` �/�l c-•'��a�,., � � � �`� SYs_ e��... �3-s �P "___..__....i..__..4—._. i _. ..i.__ _..}—'__..r._ . . . . .. .. . . ._"."..�.___y-.. .-�: ... . _ � _. ___. .� .... '.. ... . ..• �.. .... � ..... . . . ^ . . . , � � �Y'/�r_ {V' � .. • . � . . .. . . IQ . . , . " � � . i . . . ' : i . " _ ' _.._.:. .._......_:_.... .. .. ....:-.- ...... . . . .. . . .__. . .. . . . _, . . .�. . �.___...1 .. .__�__1-.... ____ . "___. ._____. � . , . . � i . . O�t � : , ... . . . ...._.: :.. ._... ...:..___ a.___. .. _....... . . ._..____ . . . ...,. . . ...t .. ... ...i.__._. •._ .__-j.... :... ...� __._ '...'_'__' . �' . . . . � � i '.. . .. . . �. . . . . ! ' . � . .: __ , 6 , _ �j , , � . . _ _ , , � �a c ����_ . � � � ` �� �Q�, � ' �^� �o , � UK�.�b ,�,�s �l�/ ��� �'',�,\�,�� `,� ��S ' ���� � � � �D f� . I � Q' �tJ���w ! ��M �� I � �- �y.�� � � ? � -�---