HomeMy WebLinkAbout002-109-63-0200-SAN-2021-392 -�•k`'"'"��> PRIVATE ONSITE WASTE TREATMENT county
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%X'�a �����, SYSTEMS Sawyer
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�=�������'� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� — 3�o�
Personal infonnation you provide may be used for secondary puiposes[Privacy Law,s. 15.04(L)(m)]
Permit Holder's Name: ❑City ❑ Village I�(Town of: State Plan Transaction ID#:
`Sa.so� Bc-e,�-h.e,s.ar �-a� . gass La� r-
Insp BM Elev: BM Description: Parcel Tax No:
�oo.a ` �� ��� oo� -� 09 - 63-020�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark �po.o�
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht outlet
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TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet •
AIRINTAKE
Septic NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. Q 9,YY �
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION �nfiltrative r
Surface Q$��6
Manufacturer Demand Finai Grade
Model Number GPM ; �T� �'4.S 6�
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS �N 3 L ' #of Cells � Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters o GP ❑ Chamber Model Number:
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CELL TO �5 -j-�p k�ti .f-,� ❑ Mound o Other
---- -- - --__-- -
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 I
- -- �----___
SOIL COVER __
Depth Over Depth Over I 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 required?�Yes O No � 0 3 pc,� �� ---�� /„ -------JI �`� ��t b
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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 AN� SKETCH
SANITARY PERMIT NUMBEA:___�L�__f 3°r�
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