HomeMy WebLinkAbout026-939-09-5110-SAN-2023-114 � � ��"�`�,, PRIVATE ONSITE WASTE TREATMENT co��ty
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��,�Sps � ( POWTS) Sawyer
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""" '��� INSPECTION REPORT sa�itary Perrnit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � �^ ��� ��/
Personal 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#:
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Insp BM Elev: BM Description: Parcel Tax No:
��� •�� I b a � � 1 � Cl`S-�/' ��� ��-6 r�3�^D�_S�l C�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark �op_v�
Dosing
Aeration Bldg. Sewer --,
Holding �,,�;�c�.�,,f �p St/Ht Inlet �,qs '
TANK SETBACK INFORMATION St/Ht Outlet �'6.7S�
TANK TO P/L WELL BLDG VENT TO ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man.
Holding �S� �ca�� $ �-�� ��.5� 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 �N L #of Cells Type of System Distribution Media Manufacturer'
SETBACK OHWM of Nav ° Conv ❑ Aggregate
P I L Bidg Well ❑ IGP ❑ Chamber
INFORMATION Waters � AG ❑ EZFIow Model Number:
CELL TO ❑ Mound o Other
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DISTRIBUTION SYSTEM X Pressure Systems Only
Lengthr I Manifold Dia _1 L�engthution Pipe(s) Dia Spac _ I' X Hole Size ;, Spacing ❑Yes ati❑ Nioes �i
SOIL COVER
Depth Over �epth Over ; Depth of � Seeded/Sodded � 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 03 II 6"7 ��� � �' G 1 �(b _
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITI�NAL COMMENTS AN� SKETCH
SANITARY PERMIT NUMBEA _ a-3 -� I�____
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