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HomeMy WebLinkAbout032-540-31-5217-SAN-2021-390 °' ' `` PRIVATE ONSITE WASTE TREATMENT county ���- �=� �`���`�o � �`�'� SYSTEMS I>( � $P ,:,,,� s ).i ( POWTS) awyer \�� �-j�� �,ti�a.�:.,.i INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION 2 I _ 3� Personal intbnnation you provide may be used Yor secondary purposes[Privacy Law,s. 15.04(1)(m)] � Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#: INaY� ��� (�,�„��-2r — Insp BM Elev: BM Description: Parcei Tax No: �p�,�' � 03,.2 -�-ya - 31 -S�1^7 TANK INFORMAT ON ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic w;,�.�- Benchmark (pa,� ' Dosing Aeration Bldg. Sewer q S,$$'� Holding St/Ht Inlet 9'��6,�"` TANK SETBACK INFORMATION St/Ht Outlet R7,,�' TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet AIRINTAKE Septic ,}- � �S'� �'� �-�'� NA Dt Bottom Dosing NA Installation Contour Aeration NA Header I Man. `��,(S'� Holding Dist. Pipe PUMP/SIPHON INFORMATION Infiltrative � Surface q 1�3S Manufacturer Demand Final Grade Motlel Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFO MAT ON DIMENSIONS N1 3 L d` ?�� �j ` #of Celis 3 Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate P/L Bldg Well ❑ IGP ❑ Chamber INFORMATION Waters � AG � EZFIow Model Number: CELLTO +.�5� �'�.S'� 5b� '�-sU ❑ Mound � �ther - - - --- - —- - - --- DISTRIBUTION SYSTEM X Pressure Systems Only — __ --- --- ---- - Header/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 Cell Center Cell Edges Topsoil_ __ _ __ � ❑Yes ❑ No ❑Yes ❑ IVo COMMENTS: (Include code discrepancies, persons present,etc.) ��-,.s�l(� << <� (� � — --1 � Pian revision required?�Yes❑ No �� �� �3 � - I �j��(� �- - - � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITIONAL COMMENTS ANO 5K TCH SANITARY PERMIT NlJMBEA: ���',��(O �� �k, �- -���,�l�r. o �-�.s , . �-�-�°l� _. _ ._--�__ :_-:-- --- .___._ _ _. _ _ ,__ C� o` F : . o . , . _. - - _ . . t a�, , . . � , �' � � -- . __ . ._ �� ._ _ _ _ � _ � . ; . d . . . .__, . ; . , : 3 :_ � , S . _ .: . :__ ;_ , � r _ __.. ; _ . � , � �, ; w i es,s21' . ` � I a-S'I> , �� �� � �'I Pa�r Pa"�'` �,� � l` _o---- �' .�, Y�d�. � �W�D�` 1 p srh�� Iw�- �'Y"`� a��� �"-