HomeMy WebLinkAbout032-540-28-5101-SAN-2023-113 � "'''f� PRIVATE ONSITE WASTE TREATMENT County
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SYSTEMS Sawyer
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"' ��''' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �3 — � ( �
Personal infonnation you provide may be used for secondary putposes[Privacy Law,s. 15.04(l)(m)] �
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
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Insp BM ev: BM Description: Parcel Tax No:
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TANK INFORMATIO ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,�p�- -7� Benchmark (o0,a�
Dosing
Aeration Bldg. Sewer q 3,'7 �
Holding St/Ht Inlet ,a�
TANK SETBACK INFORMATION St/Ht Outlet 9 � � '
TANK TO P/L WELL BLDG vENT ro ROAD Ot Inlet
AIR INTAKE
Septic �,1.5� �� � (�( NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. $`�,p �
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative �d,
Surface '
Manufacturer Demand Final Grade
Modei Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFO MATION
DIMENSIONS �N ?�,1 L c�Y` �(Y� #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav Conv o Aggregate ���
INFORMATION P/L Bldg Well Waters � IGP � Chamber Model Number:
❑ AG ❑ EZFIow
CELL TO �,p` N ❑ Mou nd o Other Q Y�
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DISTRIBUTION SYSTEM x Pressure Systems Only
Header/Manifoltl �Distribution Pipe(s) I X Hole Size X Hol� Observation PipE;s �
Length Dia _ Length _ Dia _ Spac _ �� Spacing ❑Yes ❑ No
SOIL COVER
� Depth Over �epth Over , Depth of Seeded I Sodded i Mulched �
Cell Center Cell Edges � Topsoil ❑Yes ❑ No � ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?❑Yes❑ No io3 �-� � � ( � � i �� � �� �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AO�ITI�NAL COMMENTS ANO SKETCH
SANITARY PERMIT NUMBER'____�J-113_____
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