HomeMy WebLinkAbout024-641-24-4406-SAN-2023-130 ` "`'" `:,; PRIVATE ONSITE WASTE TREATMENT County
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,� � SYSTEMS Sawyer
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�� �°�' '� WSPECTION REPORT sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �3 .- '3 6
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)J
Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
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Insp BM Elev: BM Description: Parcel Tax No:
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TANK INFOR ATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �/��S�' -� Benchmark (�p,� �
Dosing
Aeration Bidg. Sewer --
Holding St/Ht Inlet �
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TANK SETBACK INFORMATION St I Ht Outlet gy,�G'
TANK TO P/L WELL BLDG vErvrTo ROAD Dt Inlet
AIR INTAKE
Septic -}-�u �-aj� �( � .�-� � NA Dt Bottom
Dosing NA installation
Contour
Aeration NA Header/Man. �9,a,'
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative 9���
Surface
Manufacturer Demand Final Grade
Modei Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Weli
DISPERSAL CELL INFOR TION �. �
DIMENSIONS W 3 � � �� #of Cells Type of System Distribution Media anufacturer:
SETBACK OHWM of Nav Conv ❑ Aggregate �..� ,
INFORMATION P/L Bldg Well Waters °� GP � Chamber Model Number:
n EZFIow
CELL TO �b� '���` .�-S2, .�� ❑ Mound o Other � y,�
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DISTRIBUTION SYSTEM x Pressure Systems Only
Header/Manifold Distnbution Pipe(s) X Hole Size X Hole Observation Pipes�
Length Dia �Length Dia Spac i � Spacing ❑Yes ❑ No �
__---_—_ _
SOIL COVER
Depth Over Depth Over �epth of Seeded/Sodded Mulched
Cell Center �Cell Edges �'� Topsoil __ � ❑Yes ❑ No ❑Yes ❑ Nu
COMMENTS: (Include code discrepancies, persons present,etc.)
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Plan revision required?�Yes❑ No �3 p� - c/1 � � I, ��� (� �
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
ADDITIONAL COMMENTS AN� SKETCH
SANITARY PERMIT NUMBER: �3- �3d __
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