HomeMy WebLinkAbout010-841-28-3104-SAN-2021-403 -����''"'"f�'-; PRIVATE ONSITE WASTE TREATMENT county
X�'��� !'�'� SYSTEMS Sawyer
;` `�SPS ' ' ( POWTS)
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' "�� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � � � C�63
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#:
�W `�\ � lAM$ah TI wa�al ^
Insp BM Elev: BM Description: Parcel Tax No:
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TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic '� o6p Benchmark � (oa q � ��,d�
Dosing
Aeration Bldg. Sewer ,S Q�. �
Holding St I Ht Inlet 6.� ' ��.,1�
TANK SETBACK INFORMATION St7 Ht Outlet 6 9S� `I Sp's'
TANK TO P/L WELL BLDG VENT TO ROAD Dt Inlet '
AIRINTAKE
Septic � ��� �3 ,}1 NA Dt Bottom
Dosing NA Instailation
Contour
Aeration NA Header/Man. 7,0' `j �� �
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infi�trative
Surface
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 � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav Conv � Aggregate
INFORMATION P I L Bldg Well Waters � GP o Chamber Model Number:
❑ EZFIow
CELL TO ❑ Mound o Other
DISTRIBUTION SYSTEM x Pressure Systems Only
Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia �ength Dia__ _ Spac _ �____ ____ Spacing ❑Yes ❑ No _
SOIL COVER —
Depth Over Depth Over 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 � No � p3 (U �d � ��r�- /.� ' G� � ��
Use other side for additional information Date POWTS Inspector's Signature J Certification Number
SBD-6710(R.3I01)
AODITIONAL COMMENTS ANO SKETCH
SANITARY PEAMIT NUMBEA: ���d�__
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