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HomeMy WebLinkAbout010-841-27-5323-SAN-2022-006 �� '` PRIVATE ONSITE WASTE TREATMENT county �������� ���� SYSTEMS '�i �Sp �,�; Sawyer `��H � s��� ( POWTS) °`T-'=��y�"� INSPECTION REPORT Safety and Buildings Division Sanitary Permit No: � �� (ATTACH TO PERMIT) �— GENERAL INFORMATION � '� .- 3�� 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#: �%�c1/� a'`^"' 1'2, `((v v�\�eV� q wa ^ Insp BM Elev: BM Description: ��� _ cT��a Parcel Tax No: loo�a� ♦ 1Uq�� ;�, � ��..-��.s� s«,�t.e�.,. �.'``,� o(� -- �Y( -��-5'3�3 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic ��,C,,�I 12S7j Benchmark �pa,o' Dosing Aeration Bldg. Sewer 93, � Holtling St I Ht Inlet C� � TANK SETBACK INFORMATION St/Ht 0utlet ��,q6� TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet AIR INTAKE Septic �}�o k�' 7 ' t-"1 � NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. ���o� Holding Dist.Pipe PUMP/SIPHON INFORMATION Infiltrative i Surface ��� Manufacturer Demand Final Grade Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist. To Well DISPERSAL CELL INFORM TION DIMENSIONS W 3� L �{S' (,o` �a� #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate �� � INFORMATION P�L Bidg Weli Waters o IGP � Chamber ❑ AG ❑ EZFIow Model Number: CELL TO -F� -1-� �7S oo� ❑ Mound o Other �� � DISTRIBUTION SYSTEM X Pressure Systems Only Header/Manifold Distribution Pipe(s) '� X Hole Size X Hole Observation Pipes Length Dia 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: (Inclutle code discrepancies, persons present,etc.) ���ll¢.�,� s�r- _ ��(4 �a� „� �, �� „ S�S = �' �21�.� ��',' "' Plan revision required?0 Yes ❑ No p 2 � �-3 [____.�^--- -_ I �9� �� Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITtONAI COMMENTS ANO SKETCH SANITAAY PEAMIT NUMBEA'_ �1_- 3Y� _ '�- ,��..,�,d (�I�.�- . . : . . : _ : _ ; _ , � , � : . . . ' _ : , I , :_ --- :-- -�_ :_ _ ___._ - �- - - - -- --- , . . , . . . _ . , .'_T_ ' __._:_ .",- '-.. � ' ' 4 ` \` :. ... . . . . . . :.. _... ._... A� . , . . . ' .. . I . .... `y . ._ ..: ...._ ... .. i ; 0` •l` , . __ : c.i � � , : _ � _ . ; _ _: , �- - _ _ ; -:-_+ -�--- -+__ ' � ' . .____ I , ---; -� - - , , . :_ . 9�.f . , ; . ._ 1 .. .__ _._ . , • , , , ; ��3 v �� : : _ s ,�,,�� � �� ,?�� . . . _ , � ,p g� . �� � / ` °�3�— ��t� ��L � � � �—� -�, a� c-�fid�..�� � � � I I � I , �-� � l�J _.�' � '2 �c �c �`�) o�,�°� � ��� �t�S� � ' :�-� � -��� �� �` ��` �Pd— S�-- �