HomeMy WebLinkAbout010-840-27-2401-SAN-2021-412 - ��-'=`"'`"E':r; PRIVATE ONSITE WASTE TREATMENT co�nry
�_;'���$ ���\'� SYSTEMS Sawyer
`�;��� rs ( POWTS)
\HUf,`=._/��'' ���
z"�"��`" INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� r c�I�
Pecsonal infonnation you provide may be used for secondary purposes[Privacy Law,s. 1�_04{1)(m)] �
Permit Holder's Name: ❑City ❑ Village [!�Town of: State Plan Transaction ID#:
oq�;� �-Cw�y l PG1�, �aYw4� �
Insp BM Elev: BM Description: Parcel Tax No:
���.�r O'� wQ �'s � r^.�py�.. a � ��� �— O (�—aZ7" 2 YD �
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,�,�q�t� �,2 Benchmark p,�� 0�•$g� �,a '
Dosing _ c,�...�� —7$7�
Aeration Bldg. Sewer ,g3 � 9 5�o �
Holding St/Ht Inlet 6,$3 � �(�(psr
.
TANK SETBACK INFORMATION St I Ht Outlet ,o$ ` � �3.$�
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic k � .}��� +a.S` �-1.�� NA Dt Bottom y� ,( � $`j.���
Dosing �, � r N NA Installation
Contour
Aeration NA Header/Man.
Holding Dist. Pipe r ��q i
PUMP 1 SIPHON INFORMATION �nfi�trative
Surface 3 � �t3.7S�
Manufacturer Demand Finai Grade
Model Number � GPM �i �'7' S9 � � .�g�
TDH� Lift Friction Loss Sys Head TDH Ft 6•� � 9 .75�
Forcemain L p� Dia �" Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav }� Conv ❑ Aggregate ��qfi
INFORMATION P I L Bldg Well Waters o GP ❑ Chamber Model Number:
❑ EZFIow
CELL TO a Mound R� Other
--— --- -- ---- -----
DISTRIBUTION SYSTEM X Pressure_Systems Only
9 9 - ---- P-- —� -----
Header/Manifold Distribution Pipe(s) I X Hole Size X Hole Observation Pipes
Len th Dia _ Len th Dia S ac �_ ___ '; Spacing ❑Yes ❑ No
SOIL COVER _— __
-- -- . __ -- —
Depth Over Depth Over ' Depth of Seeded/Sodded Mulched
Cell Center Celi Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
��s�►1!� �2(� ( �-I
Plan revision required?�Yes 0 No �— I ^ � ��; �v�'��
c�3 � co �a] �--� - - -�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
ADOITIONAL C�MMENTS ANO SKETCH
SANITARY PERMIT NUMBER _��_�(�_
0�'� .
���
� �
�
_ ___ _ .
,
. _ . : .
,. __ . :
, , ,___ , _ . .
, ,
�
� ;��.
;
������ � ��
���
����Ib�� �;��.M
,
Ko
_----�
�
1pO h
G4���
��
-�'
D �v�
�3�
��
� �
`�°
��
5 =