HomeMy WebLinkAbout012-740-14-2412-SAN-2023-123 , -"� :;, pRIVATE ONSITE WASTE TREATMENT county
-� � o$p ,�� SYSTEMS SaWyer
��'�,� � � % ( POWTS)
��'U ` .. .,E`./;
' ""' WSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �3 �-- 1�.3
Peisonal 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 Tra�saction ID#:
�.V��12� � C�,.S� �� �� ��l
Insp BM Elev: BM Description: Parcel Tax No:
(U�cc.7 � N�. C�rv�/' a�c5`�a''eJsZ- C�l;2��`-(t�� ( ����(,�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic � -- �a� Benchmark �pp,p�
Dosing r--�,,,,,,bo 7�j
Aeration Bidg. Sewer �,,5'
Holtling St I Ht Inlet �'I,g �
TANK SETBACK INFORMATION St I Ht Outlet �t�,7 '
TANK TO P/L WELL BLDG vENTro ROAD Dt Inlet
AIR INTAKE
Septic -4�0` �-�. � 2�� ,F,2o � NA Dt Bottom �3•C-�.'
Dosing � �� w . NA Instaliation
Contaur
Aeration NA Header/Man. �jS;�S�
Holding Dist. Pipe
PUMP 151PHON INFORMATION �nfltrative 9,�f g� c
Surface
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INF RM TION
DIMENSIONS W 3 L � o' 60' �j' #of Celis y Type of System Distribution Media ManufaCturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters o IGP ❑ Chamber
❑ AG �' EZFIow Model Number:
CELL TO � �-(v �b '}-�oo ❑ Mound o Other
—— ---- — — -- — ---
—_ ---
DISTRIBUTION SYSTEM X Pressure Systems Only
� � — ----- --- I ---
Header/Manifold Distnbution Pipe(s) i 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
�
Ceil Center Cell Edges ; Topsoil __ � ❑Yes ❑ No � ❑Yes ❑ N�
COMMENTS: (Include code discrepancies, persons present,etc.)
��/� (d�3,l��
�_�__.__� ;
Plan revision required?❑Yes❑ No 103 G� � � �j G� �
��� � _ __� � t.� �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITI�NAL COMMENTS ANO SKETCH
SANITAAY PERMIT NUMBEA� _ �3 =1�3 _
I`���� .
C��\\
�
`� ��� ` � N��t}'
��` ~ I�-Sa�'.,S,D�--
� � ' d 3�� W r�, .,
�� �� `� �Y� � `"T $t���PI�r
� �\
�'`� ;��l��lb��, � �
� .
�
� 7" �i
\' L
C
��
�'.s,,�
,�-<< �
� ,
����^ \
`
�
�
��,�-- 6�'� �
�
� �a�
��
Co.� `� c� " C�� ��
fio � 6� �
� � � $��� 1 � �b�
5�4—
� 8�1�� � �b�-'