HomeMy WebLinkAbout022-738-17-4203-SAN-2023-115 ,;�
� ��"�M��; PRIVATE ONSITE WASTE TREATMENT cou�ty
��� B$ �: SYSTEMS Sawyer
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�""'-�` INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� _/ I ��'
Personal infonnation you provide may be used for sccondary purposes[Privacy Law,s. 15.04(1)(m)] �
Permit Hoider's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
I �'ISC��ojy �2` 2 `L� lea�/` �SSo v� �—
Insp BM Elev: BM Description: Parcei Tax No:
�oo.o` `j�� d r.,���. ns�-�r- Ir� o�, -��k �� �73 S- c7- K�c3
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark (oo.o�
Dosing
Aeration Bldg. Sewer �-("�.35�
Holding ,S�,L,�vJ (���'�p St/Ht Inlet �7,o '
TANK SETBACK INFORMATION St/Ht outlet �6,$ '
TANK TO PIL WELL BLDG vE"T To ROAD Dt Inlet
AIRINTAKE
Septic NA Dt Bottom � `'a,7�
Dosing NA installation
Contour
Aeration NA Header/Man.
Holding �IaS -$D` (3 �t 3' G2,�� Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative
Surface
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Frictio� Loss Sys Head TDH Ft
Forcemain L Dia Dist. To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W L #of Cells Type of System Distribution Media Manufacturer'
SETBACK OHWM of Nav ° Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters � IGP ❑ Chamber Model Number:
❑ AG o EZFIow
CELL TO ❑ Mound o Other
----- - - _ _--- - —...---- ---_ _---
DISTRIBUTION SYSTEM x Pressure Systems Only
- -___ _- ___—T
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 Depth of Seeded(Sodded Mulched�
Cell Center Cell Edges Topsoil � ❑Yes ❑ No I ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
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Plan revision required?❑ Yes❑ No !03 bB eZ ' �j� � �
Y ` _ j .��
Use other side for atlditional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIONAL COMMENTS AN� SKETCH
SANITARY PEAMIT Nl1M8EA: �-3'I�S-
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