HomeMy WebLinkAbout024-741-30-1103-SAN-2023-064 �'-"f`'' PRIVATE ONSITE WASTE TREATMENT county
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'.`l��sPs � ' SYSTEMS Sawyer
�, ,�—�� ( POWTS)
""`' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �3 � 6��
Personal infonnarion you provide may be used for secondary purposes[Privacy Taw,s. 15.04(1)(m)J
Permit Hoider's Name: ❑City ❑ Viliage Town of: State Plan Transaction ID#:
SA �tzS��,e �r�,-�r 1�r.�J. Cal� ^
Insp BM Elev: BM Description: Parcel Tax No:
��.� � 1b 6�' �-'��� O.2Y^��((.-30 -���3
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic e���� �aotl `" �e�►�+ 3�p �,,; Benchmark �p�_a�
Dosing St 1 o�T ,�.3
Aeration g�_
Holding St/Ht Inlet ��. �?j
TANK SETBACK INFORMATION St/Ht Outiet �
TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet
AIR INTAKE
Septic �j" +- 7- � i NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. �
Holding Dist. Pipe
PUMP!�IPHON INFORMATION Infiltrative �
Surface ��.5-
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L � Dia Dist.To Well
DISPERSAL CELL INF RM 10
DIMENSIONS �N ,3 L �( �B �y #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate ,�y��1'
INFORMATION P/L Bldg Well Waters � IGP �, Chamber Model Number:
❑ AG ❑ EZFIow
CELL TO � � .}-� +� ❑ Mound o Other �
__ — -- . -- — — — ——--__ - �--——
DISTRIBUTION SYSTEM X Pressure Systems On�y
Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes '
Length Dia �Length Dia Spac ' _ i Spacing ❑Yes ❑No �
SOIL COVER
Cell Center Cel�l Edges Depth of � Seeded/Sodded Mulched
De th Over De th Over I
� � Topsoil __ _ I ❑Yes ❑ No � ❑Yes ❑ N�
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?O Yes ❑ No ��03 ,U�{o��( I II ' j ��7�'j � �
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITI�NAL COMMENTS ANO SKETCH
SANITARY PERMIT NUMBER�_ �3'` ��
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