HomeMy WebLinkAbout024-741-16-1202-SAN-2023-085 �-,,
"""'�`r; PRIVATE ONSITE WASTE TREATMENT Cou�ty
�y�"� a� SYSTEMS SaWyer
��;.�� P$ ( POWTS)
'\� �—�%'
INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �3 �p$S
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)J
Permit Hoider's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
1`�`i(�,q2` �' a`�I il"`�Q`� 1��� l.o��R_. �—
Insp BM Elev: BM Description: Parcel Tax No:
c c�o,o ` '�o� w2 I l �1�� o��-7Y(-t� -(�-��
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,,,;Q�- (vo0 Benchmark op_p '
Dosing
Aeration Bldg. Sewer �6�
Holding St/Ht Inlet 9g:�(/ �
TANK SETBACK INFORMATION St/Ht Outlet �rS:t 7 '
TANK TO P/L WELL BLDG vENr To ROAD Dt Inlet
AIRINTAKE
Septic �.�' �.�,5� ` .��j ` NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header I Man. 43�,�"�
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative ,
Surface �'�•�
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFO MATION
DIMENSIONS W ` L g g #of Cells Type of System Distribution Media Manufacturer:
Conv ❑ Aggregate i
SETBACK P�L Bldg Well OHWM of Nav o IGP 4� Chamber '
INFORMATION Waters � AG n EZFIow Model Number:
CELL TO �� ,30 60 '}(oD ❑ Mound o Other Q��
---- ---- — .____ ---- ---.-_ -- --- --
DISTRIBUTION SYSTEM X Pressure Systems Only
Header I Manifold Distribution Pipe(s) � X Hole Size X Hole Observation Pipes�
Length Dia _ �Length Dia _ Spac I _ _ Spacing ❑Yes ❑ No �
SOIL COVER
Depth Over Depth Over � Depth of Seeded/Sodded � Mulched 1
Cell Center Cell Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No �
COMMENTS: (Include code discrepancies, persons present,etc.)
��,S�lf� �I���� 3
Plan revision required?❑Yes❑ No ,�3 �' � I� � — �c��(/
�_._1 _� b
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AO�ITIONAL COMMENTS ANO SKETCH
SANITAAY PEAMIT Nl1MBEA:_____���C�g�__
1 �,�
�o
�.t(iu-
[l ����
�4�r �
CwJ �s . �'`�� �
38 , .�� �1�
� q ��
� y� . _�(�__\ 6�
, �
�fs� `,
r
� � ' f �vr
o �
� I�1 � •
�
� � il
� ��
I �
�
� �
���� �� <<,�
�` ��
..�'�' `
�o��'
�--
S,�h�� ��---