HomeMy WebLinkAbout026-152-00-0600-SAN-2023-073 � ` '`"E�=:; PRIVATE ONSITE WASTE TREATMENT county
=���as�� � SYSTEMS SaWyer
���,-�.� Ps ,�,'' ( POWTS)
.�� � ��_,���i
kU> ��,
� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �3—67�
Personat infonnation you provide may be used for secondary putposes[Privacy Law,s 15.04(1)(m)J
Permit Holder's Name: ❑City ❑ Village [�Town of: State Plan Transaction ID#:
���n fi�{N� �ti�a�� S� �V� ^
Insp BM Elev: BM Description: Parcei Tax No:
�C7d.c7� � 6�S�10 U�-6� �S�—00—O�oOZ)
TANK INFORMATION ELEVATION DATA �
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,,;Q�- ""7� Benchmark oo,p`
Dosing
Aeration Bldg. Sewer 1�•lS
Holding St/Ht Inlet 5$•nS
TANK SETBACK INFORMATION St/Ht Outlet 9�.$Z'
TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet
AIR WTAKE
Septic •r�o' ,�(-, ,t-$ ' NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header I Man. �$' �
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative 9,6 �- �
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 3 L�'�� #of Ceils Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate �`� �
INFORMATION P/L Bldg Well Waters � IGP � Chamber �
❑ AG o EZFIow Model Number:
CELL TO S � �}-Sb ❑ Mound o Other � �
_--- _ - — ---- --------
DISTRIBUTION SYSTEM X Pressure Systems Only
-- _ _-- —_ — __— .—_
Header I 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 I Sodded Mulched
Cell Center Cell Edges Topsoil ❑Yes ❑ No T�Yes ❑ �d�
COMMENTS: (Include code discrepancies, persons present, etc.)
����1�' 6���23
Plan revision required?❑Yes❑ No I p3 I�0�( ��. � �J��- ---— � b�i �j/
`/ , �b �
G—
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITIONAL COMMENTS ANO SKETCH
SANITARY PERMIT NUMBEA:____�� G7�__
�—S�``� 1T��2. �.
� �•
�
$` � �r�
��
�� a �s�,��
��. ►
, �,� � � ��.
. �
z �
� �
s s s •
Q�t't-
0 0 .S�'j '���
�5) �51 (S) a
r(a' Cb�
�
g�5� �n���
�°r'ns 1�`.
-�(�' �� �2�`'�
��b
.�
_ _ I �� " 7�
N� s�..
�