HomeMy WebLinkAbout010-145-00-2600-SAN-2023-111 ,
'""'f>�� PRIVATE ONSITE WASTE TREATMENT County
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-J�lo SYSTEMS
':���Sps ( POWTS) Sawyer
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`x "��'� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION ��_ � I I
Persona(infonnation you provide may be used for secondary purposes[Privacy Law,s. l 5.04(l)(m)] �
Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
K�Vt�n ��t�"i� Il��'►�t1� �AYv.�0.� ^
Insp BM Elev: BM Description: Parcel Tax No:
��a'�� l���l /V` s;d-+�. a�-'1�+r.�., n�.J,n.�� �,��N oto- I�(S-Do -�oc�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic ;� �a� Benchmark �yp.p�
Dosing
Aeration Bidg. Sewer 9 �j p �
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Holding St/Ht Inlet � ,(, �
TANK SETBACK INFORMATION St I Ht Outlet q�, �( r
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic �o` ��(o t-,LS� +-1S� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. j(,,'7 �
Holding Dist. Pipe
PUMP 1�IPHON INFORMATION Infiltrative
Surface ��'•�r
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFO ATION
DIMENSIONS W 3� � (p� �j0� #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav Conv ❑ Aggregate
INFORMATION P�L Bldg Well Waters � GP ❑ Chamber Model Number:
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CELL TO (D �p „ � � ❑ Mound o Other
— ----� --- � — - —
— --- -- —__
DISTRIBUTION SYSTEM 5�� ' X Pressure Systems Only
— _ __- -----�--- - -_ _ _ _ _--
Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes �
Length Dia Length Dia Spac ' Spacing ❑Yes ❑ No �
-- ---- --- �
SOIL COVER
_ _ - -- - ,I--- — - - -
Depth Over Depth Over Depth of Seeded 1 Sodded Mulched
Cell Center Cell Edges I Topsoil ❑Yes ❑ No ❑Yes ❑ N�
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?�Yes ❑ No ; 03 � U'7 � —
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
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