HomeMy WebLinkAbout024-741-33-2402-SAN-2023-084 -�=�%'`=—"''-'��`:�� PRIVATE ONSITE WASTE TREATMENT county
� ���og � l SYSTEMS
�,�,.� Ps � ; ( POWTS) SaWyer
�k �-P`:/
° ""�" INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �3 �.QB y
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village [�Town of: State Plan Transaction ID#:
S��v� i��/' f��51 c G lv 'q�1 1�� lsi� ^
Insp BM Elev: BM Description: Parcel Tax No:
(pc�ac� � o� w2�` 0�.�( ��`C(--33 —�Y�a
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic w;�s�r -- �d� Benchmark �vo,o '
Dosing .—w„h�jo �ya
Aeration Bidg. Sewer --
Holding St/Ht Inlet �3 r
TANK SETBACK INFORMATION St/Ht Outlet �g. ( '
TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet
AIRINTAKE
Septic '�",�� fi�` N NA Dt Bottom ��,� �
NA Installation
Dosing �� « • y Contour
Aeration NA Header/Man. 9 Y,$ '
Holding Dist. Pipe
PUMP/51PHON INFORMATION Infiltrative
Surface `�Y�v �
Manufacturer �`„� Demand Final Grade
Model Number 3 GPM K�y4 �t"]-, QS 3 �
TDH p Lift Friction Loss Sys Head TDH Ft
Forcemain L �-�o Dia � " Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W � � (,p� p� #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
P/L Bldg Well ❑ IGP ❑ Chamber
INFORMATION Waters � AG ,� EZFIow Model Number:
CELL TO -�tp N � � ❑ Mound � Other
—���-- — — -- -
DISTRIBUTION SYSTEM X Pressure Systems Only
____ -- — —
Header/Manifold Distribution Pipe(s) I X Hole Size X Hole Observation Pipes �
Length Dia Length Dia Spac __ � _ Spacing ❑Yes ❑No �
SOIL COVER
Depth Over Depth Over �Depth of Seeded/Sodded Mulched
Cell Center 1 Cell Edges , Topsoil � ❑Yes ❑ No � ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
�-��+��� l�� ► � ��3
Plan revision required?❑Yes❑ No I�� �� � , — �� G�j � �� �
J
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITI�NAL COMMENTS AN� SKETCH
SANITARY PERMIT NUMBER: _��ag�__
�
� I� � _ _ ' . ,
I � � �
� I i � �
II I �
I I I I f\b��
�! U (� � � `��� � �'r�
�^ L t �
� � _ �
t ����
. / ���.,.��
1 '�`�v
i
i ,�
3� � � � �,r
�..CiW�
��� � �o ��"� �.
w:�
� , 1�,�ao
� � v,� �4
����b�
—�
�--- �� V��� �-
���-