HomeMy WebLinkAbout010-941-36-2101-SAN-2021-405 -'"�`""""t> PRIVATE ONSITE WASTE TREATMENT county
;_�;'i�sPs �;�'; SYSTEMS Sawyer
`�.�� � ( POWTS)
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�'"�+'�"''�" INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2� — �{OS
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#:
1 �Mo v� a �a� -
Insp BM Elev: BM cription: Parcel Tax No:
�pD.o� � o Sla'� � Q��S'�-�\ C710 �9�(( _ 3� -��aj
TANK INFO MATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,,,;c�� pc,p • Benchmark ^� ' vo � � (po,o�
Dosing �
Aeration Bldg. Sewer �S'�' �'7 �
Holding St I Ht Inlet .33� �;�-S'�
TANK SETBACK INFORMATION St I Ht Outlet b.� ' �f 6.3�-�
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic �.y� .��' �t�� ��o ' NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. `7 0 � qs�q`
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Surface e �•� � �'t ,`j �
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist. To Well
DISPERSAL CELL INFO MATION
DIMENSIONS �N 3` L by b #of Cells a Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ aggregate �.�I ,
INFORMATION P/L Bldg Well Waters °� G � �hamber Model Number:
❑ EZFIow
CELL TO -��� -�(o .+(�e o Mound o ��ther QYt
--__ _— �__ _
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distribution Pipe(s) — — I X Hole Size X Hole Observation Pipes �
Length Dia Length Dia Spac 'L _ Spacing ❑Yes ❑ No J
SOIL COVER
Depth Over Depth Over Depth of Seeded/Sodded �Mulched �
Cell Center �ell Edges I Topsoil ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies,persons present,etc.)
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Plan revision required?O Yes❑ No �3 �� �2J �L� ��^O� �I �`1J6 �b
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Use other side for additionai information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITIONAL COMMENTS AN� SKETCH
SANITAAY PERMIT NUMBEA:___��_��_
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