HomeMy WebLinkAbout008-213-00-0800-SAN-2021-410 �'�'�""'-""`�; PRIVATE ONSITE WASTE TREATMENT county
,,,,
>�`i�os� � '�, SYSTEMS
;-,�� s � , ( POWTS) , SaWyer
ry � P/,
��"y^ INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION '�` _ (.��p
Petsonal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(�n)]
Permit Hoider's Name: ❑City ❑ Village [�f Town of: State Plan Transaction ID#:
�. �N�„� T-��,q� �- ,� ^
Insp BM Elev: BM Description: Parcel Tax No:
����� � c�c.. t�aB-�t3 _00-6860
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic ,,,,�e eS ( app Benchmark a, 33 � lDa,33� (oo•c�'
Dosing K,�� ��
Aeration Bldg. Sewer � '
3.7 `��,63
Holding St I Ht Inlet c� �8 r � �.r
� �
TANK SETBACK INFORMATION St I Ht Outlet �j,g � ,03'
TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet
AIR INTAKE y 8 � q?,gsr
Septic .��` �-�� +3-' �� NA �t Bottom �..� ` 9 3.$3'
9 Installation
Dosin ,�5� � �� �.. � NA Contour
Aeration NA Header/Man.
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION �nfiltrative
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 Distr bution Media Manufacturer.
SETBACK OHWM of Nav � Conv o ,Aggregate
INFORMATION P/L Bldg Well Waters °� G ❑ 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 l 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 ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
S/}�
�s� � �s� ��,5-�,1� ��( �.� (�-�
� �
Plan revision required?�Yes❑ No 'D p a� �I (� —�
3 � �___�/ --- - � S�l�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3I01)
A��ITI�NAL COMMENTS AN� SKETCH
SANITARY PERMIT NUMBER: �I��f(0
�����
T�
��'''�
�� .
- ' I; I' � �� ,`
W�ewT �,,;e��'
�v��, 1� /
_ � '
/ . . ,. __ :.. . ,_ , ._ _
�5 ,
�7 l
I
�'3� �
��� �� fi�'
��-�„� �`� � 3
5�
b`� �
� ��
�
�
�� �r
-�
SCAIE 1"=