HomeMy WebLinkAbout028-782-00-0700-SAN-2023-078 ""'"'��' PRIVATE ONSITE WASTE TREATMENT County
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""" INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �,3 — ��g
Personal intonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Viliage �,Town of: State Plan Transaction ID#:
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Insp BM Elev: BM Description: Parcei Tax No:
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a .c7 wel Qo?c c�-��" Oo1 g�'7�oZ '-00' 0700
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic „�,•,e�r '7�j Benchmark (oc�•o�
Dosing
Aeration Bidg. Sewer ^
Holding St/Ht Inlet q):�'
TANK SETBACK INFORMATION St/Ht outlet Q,�;�S '
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic .t-�� }�' *�o +�a' NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. q,?,(
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infltrative �
Surface `�l• $
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' � �(S � � #of Celis o� Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters � IGP ❑ Chamber Model Number:
❑ AG q� EZFIow
CELL TO �(o -}-(p` �-� �+-tob� ❑ Mound � Other
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DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distribution Pipe(s) i X Hole Size X Hole Observation Pipe�
Length Dia Length Dia Spac , Spacing �Yes ❑ No�
--
SOIL COVER
Depth Over Depth Over i Depth of Seeded I Sodded Mulched
Cell Center � Cell Edges �: Topsoil __ ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Inciude code discrepancies, persons present,etc.)
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Plan revision required.� Yes 0 No i�3 lOs— �1�.iv lI � � � � �c� � �� �
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS ANO SKETCH
SANIT/1RY PERMIT NUMBEA:__�3�_6�___
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