HomeMy WebLinkAbout008-938-20-5409-SAN-2023-086 � ` "'"t,�; PRIVATE ONSITE WAS�'E TREATMENT County
-J��';I D . \
�, Sp : SYSTEMS Sawyer
-, � s ( POWTS)
� �
\k�fi .__./3-/ .
��s����% INSPECTION REPORT sanitary Pe�rnit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �3 `��
Persona]infonnarion vou provide may be used for seco�dary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
�q��-� ��� INI� �brk�s �� "'_
Insp BM Elev: BM Description: Parcel Tax No:
' � �
(po '`' 6� re�C�r l a�a..� y.�.� �° " ����-o-S�c�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic ; ��� �� Benchmark ��o.o�
Dosing
Aeration Bldg. Sewer
Holding St I Ht Inlet
TANK SETBACK INFORMATION St I Ht Outlet q�p�
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIRINTAKE
Septic NA Dt Bottom
Dosing NA Instailation
Contour
Aeration NA Header/Man. � SY•S�
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative Qg,g i
Surface
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 � �(r Ys #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
P/L Bidg Well ❑ IGP ❑ Chamber
INFORMATION Waters � AG ,� EZFIow Model Number:
CELL TO }�r �g } �j �-�� ❑ Mound o Other
DISTRIBUTION SYSTEM x Pressure Systems Only
-- --
Header/Manifold Distribution Pi e s X Hole Size X Hole Observation Pipes
�ngth Dia �Length PO Dia _ Spac I � Spacing ❑Yes ❑ No�
- — ---
SOIL COVER
- — — — —
Depth Over �Depth Over ' Depth of —� Seeded/Sodded I Mulched
Cell Center Cell Edges �, Topsoil _ ❑Yes ❑ No � ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
-��►���( �(� 1�3
. . q . , �3�� �� � - - _J�' � S�(� �
Plan revision re uired.�Yes � No i
I � —
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS AN� SKETCH
SANITARY PERMIT NIJMBER ____ 23 - 68G� ____
� (�-. S�fS � 1,� . �—
�a.C�
�11� ��c
��
����
_� ¢
; �
��
,
, g�
. -- � �
. �� �° a_S_ e
,� �� �,f? �
���. ,
w,��b
e,��S'C'
�s(�' � \
$� \ \�� �
���I b�, � �� '�.
� � I
\ �yr,
��
�33yo,v
�
��� ��
�9(/'�d��
�
ALE I"=