HomeMy WebLinkAbout002-940-16-1111-SAN-2023-315 ` "`""r; PRIVATE ONSITE WASTE TREATMENT cou�ty
����o$ SYSTEMS Sawyer
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' "'`-�`'� INSPECTION REPORT sanitary Permit tvo:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �-3 - 3I�
Personal information you provide may be used for secondary purposes[Privacy L.aw,s. I 5.04(1)(m)]
Permit Hoider's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
V�n C�.\L�i�.r-�t-�flse.��eh"1'1.. ��rs ��/.A
Insp BM Elev: BM Description: Parcel Tax No:
��D•`�� Nw c�r �s;�.i :,.. D�c,,.� Dc� - `i+�o—!6- ►I
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic ��� ? (a..� 7 Benchmark �pp,��
Dosing
Aeration Bidg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St I Ht Outlet q yrs�
TANK TO P/L WELL BLDG vENrTo ROAD Dt�nlet
AIRINTAKE
Septic NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. $.3,�'
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative �a �,
Surface
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATIpN
DIMENSIONS W 3 L � $Y #of Cells Type of System Distribution Media ManufaCturer:
SETBACK OHWM of Nav �C Conv ❑ Aggregate �YI,
INFORMATION P/L Bidg Well Waters � GP � Chamber Model Number:
❑ EZFIow
CELL TO �"(o -}- �rjJ� N ❑ Mound o Other Q},�
— ----- ---- — ----_ _-- --
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distribution Pipe(s) — �Hole Size X Hole Observation Pipes
g _ g _ p Spacing ❑Yes ❑ No�
Len th Dia Len th Dia S ac �, _ _
SOIL COVER
- — -- — ------
Depth Over Depth Over ; Depth of Seeded/Sodded Mulched
- -
Cell Center Cell Edges i Topsoil ❑Yes ❑ No 1 ❑Yes ❑ N�
COMMENTS: (Include code discrepancies, persons present, etc.)
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" /'` CG(l,S b�, l�
— —
, � --- - _
Plan revision required?�Yes ❑ No �
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIDNAL COMMENTS ANO SKETCH
SANITAAY PERMIT NUMBER:__�-.315
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