HomeMy WebLinkAbout032-538-11-3304-SAN-2023-117 "R'`"`:; PRIVATE ONSITE WASTE TREATMENT county
� ��o$ � �; SYSTEMS
��'�.�� �s ' � ( POWTS) Sa.Wyer
.�k �_r,�;
"` INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �3 _ I ( �
Personal infonnation you provide may be used for secondary puiposes[Privacy Law,s. 15.04(1)(m)J
Permit Hoider's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
�p y���/'!^ �.��`�l" ��\ L��`��
Insp BM Elev: BM Description: Parcel Tax No:
1
(Dc',v � o K.�. ��s�s— 1� . �3�—��3g—(I —3�0
TANK INFORMATI N ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark �O�.o�
Dosing
Aeration Bldg. Sewer c�,� '
Holding �,� CSD� St/Ht Inlet 6 r
TANK SETBACK INFORMATION St/Ht 0utlet �6.,ti �
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man.
Holding t5D` �jb (� ` �-� 1 ��S Dist. Pipe
PUMP 1 SIPHON INFORMATION infiltrative
Surface
Manufacturer Demand Final Grade
Modei Number GPM
TDH Lift Friction 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 Bidg Well Waters o GP ❑ Chamber Model Number:
❑ EZFIow
CELL TO ❑ Mound o Other
— - -- _--- - — ----__----- -- --
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 , Depth of � Seeded I Sodded T Mulched �
Cell Center Cell Edges i Topsoil ❑Yes ❑ No � ❑Yes ❑ Nu
COMMENTS: (Include code tliscrepancies, persons present, etc.)
�=��1� g��? ��3
� ��
� , - -- ---- -
Plan revision required?�Yes ❑ No I,�2,� � � �� � l �,
`� - � - ----� -- —�---
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AODITIDNAL COMMENTS ANO SKETCH
SANITARY PERMIT NUMBEA:__�3 " I�Z___
� . ; : ; ' ; , : :
���� .
��
� �
�� �h 3��.
a. -
�`� �,
� �
�
y�
,
V �/
���
V
\� ����
-�.-- �