HomeMy WebLinkAbout002-940-26-5106-SAN-2023-080 -��'�""�"=`>;_ PRIVATE ONSITE WASTE TREATMENT county
=��vs SYSTEMS Sawyer
�:,�� PS ( POWTS)
\A\ `v r:/i
"x "� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION ���p�
Personal infonnation you provide may be used for secondacy purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
�2tre (� ��u C c o 6aSS � ^
Insp BM Elev: BM Description: Parcei Tax No:
�,� ��. s•'�St. N� Co�� o0 2 �-�'�'o _�� - s��(
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic e���,.� '�� Benchmark �pp_o'
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht outlet
TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
Dosing NA Instaliation
Contour
Aeration NA Header I Man. �`_� �
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative
Surface
Manufacturer Demand Final Grade
Model Number �PM 5y5. ��� q S S �
TDH Lift Friction Loss Sys Head TDH Ft S ys. 3 f� 5 Y. S' �
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W � L �,b• ,tp' ,2 ` ' #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate �`.
INFORMATION P�L Bldg Well Waters a GP !� Chamber Model Number:
❑ EZFIow
CELL TO ❑ Other
kS' tj .)-�o� ❑ Mound Y�-
---- — ------- _ _
DISTRIBUTION SYSTEM � X Pressure Systems Only
-- __ _. �_.—
Header/Manifold Distribution Pipe(s) X Hole Size X ole Observation Pipes
Length Dia � Length Dia Spac �_ Spacing ❑Yes ❑ No
--- — -- - -
SOIL COVER
--- --- -- _ - -
�Depth Over Depth Over Depth of Seeded(Sodded Mulched
Cell Center Tell Edges Topsoil ___ � ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
��,5�((�( 6�a�(�3
��_7� i - - -- � �
Plan revision required?❑Yes❑ No j o3 I,oS- � � � � __ I �����
Use other side for additional information Date POWTS Inspector's Signature � Certification Number
SBD-6710(R.3/01)
AOOITIONAL COMMENTS ANO SKETCH
SANITARY PERMIT NUMBER: �3-�8� ___
Q�� N�j 'P\Y�`
� ��
� �
�' � i
1 ' I �
� ' I �
, �
,
Q'� `�--
! ` S
� �� � � ��
I I°) C�, � �3c' �,.,�,�5�'
� I�I �3I r� I�I � `, \ G
��I � � I I J � 1
�
. ��,�.. Q ' ��____- ``a< <
�,� ,� Yf- � , ��
ia �
� � �,iv�.
�
3°
i,,;,�:��� �.4��� �
�
w
���1� �
� ��
�_ i
s e�t-�'�