HomeMy WebLinkAbout010-941-33-1412-SAN-2023-103 '"`�'"T="��`�.; PRIVATE ONSITE WAS�E TREATMENT co�nty
_..�
; ,
'Y � o$ � `�� SYSTEMS SaWyer
`,;,��� �s , >' ( POWTS)
��R �_-i.,P`;�
° "'� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION oZ ?,^ ` 0�
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)J
Permit Holder's Name: ❑City ❑ Village (�'Town of: State Plan Transaction ID#:
�d`�a►v,Gcf� �o�s �a t,.�a� �
Insp BM Elev: BM Description: Parcel Tax No:
�oa,o' � p b � sr_ r�� 1; a►o �Yt-33-1Y�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic e��� sk Benchmark �pp�o�
Dosing
Aeration Bidg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet —
TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man.� 3-�. S �O •Y2 `
Hoiding Dist. Pipe q S-,7(�'
PUMP I SIPHON INFORMATION infiltrative 4Y�76�
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 � ` a #of Cells Type of System Distribution Media Manufacturer:
� Conv ❑ Aggregate ��2 •
SETBACK P I L Bidg Well OHWM of Nav � IGP � Chamber
INFORMATION Waters � AG ❑ EZFIow Model Number�
� ❑ Mound a Other �Y�
CELLTO t'� '��" �/ __ _ __ ____---- — --
DISTRIBUTION SYSTEM X Pressure Systems Only
g — g — p — — ' X Hole Size X Hole Observation Pipes
Header/Manifold Distnbution Pipe(s) I,
Len th Dia Len th Dia S ac ' � Spacing ❑Yes ❑ No �
- --- -
- -- --
SOIL COVER
— — - -
Depth Over Depth Over � Depth of � Seeded I Sotlded � Muiched
Cell Center Tell Edges ; Topsoil ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
��,��1� 7�� l�3
� �-eP�t`e P'"'e�' c�¢-�1S °��j
r
� �
, . . I� i� — , ���/�---�,
Plan revision required7❑Yes❑ No � iio7 I I --��� '"'� �� �1
� _ o
Use other side for atlditional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AO�ITIONAL COMMENTS ANO SKETCH
SANITARY PEAMIT NUMBER: �- ^ D
�� �
� � �
\�'� �nri,N T.
"Jj�` l,�% 1�/ �
��
�' � \��
��� �
� - - - 2�-
�.�-•`�-Y'''l .
a��
�
l—
� �
� �s��s��br
� � �a-� /�
<' � Qw�.
�
,
_ ,
.
ex� �l�
� `
D
1
5
�2\� �� - - — — - - — O
S `
�-�� � q � �--� PI ` fi., `
7
N
SCALE I"_