HomeMy WebLinkAbout032-539-10-5116-SAN-2021-408 =�'"="-T�''�^��:;; PRIVATE ONSITE WASTE TREATMENT county
i t,'i o$ ;K SYSTEMS Sawyer
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INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �,I ,� �O g
Personal infonnatio�you provide may be used for secondary purposes[Privacy L.aw,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#:
w o�M,2 7r ��\• w\.�Q� —
Insp BM Elev: BM Description: Parcel Tax No:
�c�o.o` Na�l 7� �3� —S"39 — (o-Si((�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic w�e.�— —7� Benchmark � o�:Y � ��D �
Dosing
Aeration Bldg. Sewer �6,q ' `
Holding St(Ht Inlet -7, Y ` �j�',oy�
TANK SETBACK INFORMATION St I Ht outlet 7,6�� � " � �,�
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIRINTAKE
Septic �-�o` �S-p' ��S' �j.,S-' NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. '�,gg' R .�'
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative r
Surface �-�� `�b,6�
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 3 L � � #of Cells o� Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav Conv ❑ Aggregate
INFORMATION P I L Bldg Well Waters � G ❑ Chamber Model Number:
� EZFIow
CELL TO �g fi1 � tba � ,t.$D` ❑ Other
--- -❑ Mound- --__ -------
DISTRIBUTION SYSTEM �• X Pressure Systems Only
Header I Manifold Distribution Pipe(s) TX Hole Size X Hole Observation Pipes I
Length Dia Length Dia Spac � Spacing ❑Yes ❑ No
SOIL COVER
-- — --
Depth Over Depth Over I Depth of Seeded/Sodded Mulched
Cell Center Cell Edges �I Topsoil __ �Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
��s�l� 1�.1 a� a �
Plan revision required?�Yes ❑ No 03 �p aa � - ! GR � ,
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�DITIONAL COMMENTS ANO SKETCH
SANIT,4PY PERMIT NUMBER ___�� -��___
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