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Home My WebLink About004-838-11-4102-SAN-2023-083 „s"=�""'='��`�� PRIVATE ONSITE WASTE TREATMENT county > � � �� SYSTEMS ''��$Ps ��' ( POWTS) SaWyer �r� `^�;r�� INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION � 3 _ d8� Personai infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)J Permit Hoider's Name: ❑City ❑ Village L�Town of: State Plan Transaction ID#: C,�n S�� q ��12r� 'R�.�►3..of� �oa�g�„ C Insp BM Elev: BM escription: Parcel Tax No: ��.o� N�<< �-��b�, �. a��, �,� ��- �- �� -�c �� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �,;,� — �(�p Benchmark �v�„�� Dosing ^ �,� o p Aeration Bldg. Sewer QS� � Holding St/Ht Inlet Q�6 � TANK SETBACK INFORMATION St/Ht Outlet �� Y ' TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Septic �-�� ` Y` fi�� NA Dt Bottom `jo�7 ` Dosing �� . �- NA Installation Contour Aeration NA Header/Man. Holding Dist. Pipe �'q,6 � PUMP/SIPHON INFORMATION Infiltrative �$3� Surface Manufacturer � ^ ��,� Demand Final Grade Model Number �� GPM �{o G3 �9.,3 1 TDH Lift Friction Loss Sys Head TDH Ft Forcemain L �� Dia 1� `� Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS �N ,2S L (�b #of Cells ( Type of System Distribution Media Manufacturer: ❑ Conv ❑ Aggregate / SETBACK OHWM of Nav b-►2o� P/L Bldg Well ❑ IGP ❑ Chamber INFORMATION Waters � AG � EZFIow Model Number: CELL TO �'c�` '�-�o fic�o� N�— K� Mound 1� Other --- - — __ ---— - DISTRIBUTION SYSTEM X Pressure Systems Only Header/Marnfold --_—^ Distribution Pip�e(s) — w ^ ! X Hole,Size �� , X Ho� ObYes atio❑n Pi�pes Length Dia Length� Dia �•S Spac _L p f� Spacing �_ ___ � �- SOIL COVER ---_— _ _-- --- -- � Depth Over 4 Depth Over �� Depth of � Seeded/Sodded Mulched Ceil Center �a 1 Cell Edges �� I Topsoil � � �Yes ❑ No L�Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) ��1�/ �(a��3 �-T � � G�. - - - Plan revision required?❑Yes ❑ No ' ! ' � � ” (j��l� i�3 ,� i Y� � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITIONAL COMMENTS ANO SKETCH SANITAAY PERMIT NUMBEA: 23 - �� , ; , . -- _ ._. _.. _ _ _ , __'. --: . . :_ ;_ . : - - --� _ ___ _ _ _ _ �.q��d . , , --� � ��% -� �O \�� 'r/ � ��o�� / � / \��c �.�`� , � ,,s� , � ` � ` � l �� 6�r i `Y� � e ��o � �� a d�`�. �,,c,,�si- � ��.� g,��- � ��d�� L �� . �- (� ��5 '�� C �