HomeMy WebLinkAbout028-542-12-5301-SAN-2021-385 '�"''-'-"T"`^:�:;; PRIVATE ONSITE WASTE TREATMENT county
!>�" r�,.
;:�t'�$ \ �',`�,� SYSTEMS Sawyer
�:� P$ ��' ( POWTS)
�h �—�_;
' '�"�' ' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �' � �gs'
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#:
�n�2 W 1 Yvl�1�:y}' ��2,S S �r �t�Ce._ �1"r�-11�. a�9Q(o-- C.
Insp BM Elev: BM Description: Parcel Tax No:
�oo,o` � �Q, ,� � ,`�.�_ 0�8�- �Y�2-�z�S�3a ►
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �„�f- (��{S'" Benchmark p�p' (po.o� (D�.o�
Dosing a„ ald • Q ' g�.3 �
Aeration Bldg. Sewer � ;g� ' � �,�5�
Holding St/Ht Inlet �,�,( � $S-,q r
TANK SETBACK INFORMATION St l Ht 0utlet l Y•�S ' 8S:7S�
TANK TO P/L WELL BLDG v R 1NTA�KE ROAD Dt Inlet �Y, Zg ' gs;�2�
Septic NA Dt Bottom l�.'-7 ' �� 3 '
Dosing NA Instaliation
Contour
Aeration NA Header/Man.
Holding Dist.Pipe
PUMP/SIPHON INFORMATION �nfiltrative
Surface
Manufacturer ��.� �� Demand Final Grade
Model Number �
CPS 5' GPM N: �, �'}-. � s•T. � �?,o� R3.a�
TDH`D.'►Lift Friction Loss Sys Head TDH Ft
Forcemain L ��vp Dia �" Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav ° Conv ❑ Aggregate
INFORMATION P I L Bldg Well Waters o GP ❑ Chamber Model Number:
c EZFIow
CELL TO ❑ Mound o Other _
DISTRIBUTION SYSTEM x Pressure,3ystems Only
Header I Manifold Distribution Pipe(s) 'I X Hole Size X Hole Observation Pipes
Length Dia Length Dia___ __ Spac � _ _ ; Spacing ❑Yes ❑ No
SOIL COVER
Depth Over Depth Over � Depth of Seeded I Sodded Mulched
Cell Center �Celi Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
��g�- ��� ��s�lc�1 «j 36�'� �
� s:r. �- P�T� ��x��� �`�`S
� ���
-- — __ _ —I /
Plan revision required?�Yes 0 No ��p��� � " " � ���� 1�
Ii �_ _ --—__
Use other side for additional information Date POWTS Inspector's Signature Certi f ica tion Num ber
SBD-6710(R.3/01)
A�DITI�NAL COMMENTS AN� SKETCH
SANITARY PERMIT NUMBER ___�_�__^���____
L �-�k�
w`¢,�
�l
' �^� t ��(P.�r�
• \ 4I�� `~S�r ��51 0 Cu��
� � � � � ` � - � - - - N 1�b^
I � cab�' � � � "Y�
�� � , o
�'av��? IQ - - `�"=��� � _ � '
i - , - -
�— - - —� �
� �<�IP��� .
�
��
:
�
�
:
��
�/
T� / '
�_ _
��.s s'�( ���,� 5�'�eT
�
�
C
�(� So2 6�
� s�3o
�
a�
n`�y--- �,� �
U �
�