HomeMy WebLinkAbout026-939-16-5409-SAN-2023-109 - �''"'"'-""'�s PRIVATE ONSITE WASTE TREATMENT County
�� � SYSTEMS
�`�.�gPs ���'� ( POWTS) SaWyer
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k ' ""� � INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �3 _ � �
Persona]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#:
i,,.x,.� ��a�. Wl;��� �r�� �� �--
Insp BM Elev: BM Description: Parcel Tax No:
�OD.�r 1 O O �f' �+�(A SZ,S lR lD ��`b-�3 9 +1� "S l O I
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELCV
Septic � 6�p Benchmark ��p,��
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet �'
TANK SETBACK INFORMATION St I Ht outlet �� 3 �
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic f ' ��b� �,S- .}� NA Dt Bottom
Dosing NA Instaliation
Contour
Aeration NA Header I Man. �S;p '
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative
Surface Q�`�o�
Manufacturer Demand Finai Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist. To Weli
DISPERSAL CELL INFOR ATI N
DIMENSIONS W � L ��( G�( #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate `� .
INFORMATION P I L Bldg Well Waters o GP ta� Chamber Model Number:
❑ EZFIow
CELL TO + p a�,zo� �-� o,p ❑ Mound o Other — ��
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DISTRIBUTION SYSTEM x Pressure Systems Only
—-- - __— ---
Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
[Length Dia Length Dia Spac � Spacing ❑Yes ❑ No
- — -
SOIL COVER
Depth Over Depth Over I Depth of Seeded/Sodded Mulched
Cell Center TCell Edges i Topsoil ��Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision re uired?�Yes ❑ No ��� '
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITIONAL COMMENTS ANO SKETCH
SANITARY PEAMIT NUMBER: �3� I O�__
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