HomeMy WebLinkAbout022-638-32-2102-SAN-2023-087 „ '"'-` ':_�., PRIVATE ONSITE WASTE TREATMENT County
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"'°` INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2 3—Q�?
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(I)(m)J
Permit Holder's Name: ❑City ❑ Village Town of: State Pian Transaction ID#:
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Insp BM Elev: BM Description: Parcel Tax No:
loo.o (jb,� �, S ,��� o���C�38-- 32-?10�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark pa,�i
Dosing .
Aeration Bldg. Sewer 4g,3 �
Holding ���j St/Ht Inlet g �
TANK SETBACK INFORMATION St/Ht Outlet �b 6 '
TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom 9?,� �
Dosing NA Installation
Contour
Aeration NA Header I Man.
Hoiding +(� �{ � S '+'Z.� G 2'�� Dist. Pipe
PUMP 151PHON 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 INFORMATION
DIMENSIONS W L #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav ° Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters °� GP ❑ Chamber Model Number:
❑ EZFIow
CELL TO ❑ Mound o Other
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DISTRIBUTION SYSTEM X Pressure Systems Only
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Header/Manifold Distribution Pipe(s) �ze X Hole Observation Pipes
Length Dia _ Length Dia Spac I, Spacing ❑Yes ❑ No
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SOIL COVER
f Depth Over �epth Over T Depth of Seeded/Sodded T Mulched �
� Cell Center Cell Etlges � Topsoil ❑Yes ❑ No � ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?O Yes❑ No p 3 0�' �. JI, �I� , — I, �c��j/ �
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
ADOITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBEA _���0��___
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