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�.SARTMt;1y. County <br /> , �� Private Onsite Wastewater Treatment <br /> 1- a$ps. k Systems POWTS) Inspection Report <br /> g NETT <br /> Y P P <br /> ^kq,, /�� Sanitary Permit No: <br /> �,,,,,,r�,/ (Attach to Permit) <br /> industry Services Division S► -22 -22.9 <br /> General Information <br /> Personal information you provide maybe used for secondary purposes Privacy Law,s.15.04(1)(m)] <br /> Permit Holder's Name: D City 0 Village Town of: State Plan Transaction ID#: <br /> m15V LLC (,Kevin &rei'-Iv- -SACSbN <br /> CST BM Elev: Insp BM Elev: BM Description: Parcel Tax No: <br /> t Ott•c-4- Ti,? o{ Sp'►ke 'I n -bete. t'aT <br /> Tank Information setback to: <br /> TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road <br /> Septic W itS-e..r -150 L(y' NA NIA N/A <br /> Dosing N/A <br /> Aeration N/A <br /> Holding <br /> Pump I Siphon Information Elevation Data <br /> Pump Manufacturer Pump Model Demand STATION BS HI FS ELEV <br /> Filter Manufacturer Filter Model LT p GPM Benchmarktbl• lb0 <br /> T �i <br /> TDH Lift Friction Loss Head Total Bldg.Sewer <br /> Tank Inlet LW• $ <br /> Forcemain Length Dia Dist.To Well • <br /> Tank Outlet ( .2S 10. 66 <br /> Dispersal Cell Information Dose Tank Inlet <br /> DIMENSIONS Width s i Lengtlt 2, #of Cells L�/ <br /> Dose Tank Bottom <br /> SETBACK FROM Prop.Line Building Well OHWM Inst.Contour <br /> 32 NA NA NA Header/Manifold <br /> Type of Cell Manufacturer: '�' MO '1 <br /> _ Distribution Pipe <br /> (0,:ta. 4 G -- yle 6 Model Number: Infiltrative Surface 8.2 +$ y 49.5 <br /> `19.7,. <br /> Final Grade la• 5 101 .q <br /> Pretreatment Unit <br /> Manufacturer: <br /> Model Number: <br /> Distribution System X Pressure Systems Only <br /> Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes <br /> Length Dia Length Dia Spac Spacing 0 Yes 0 No <br /> Soil Cover <br /> Depth Over Depth Over Depth of Seeded/Sodded Mulched <br /> Cell Center Cell Edges Topsoil 0 Yes 0 No 0 Yes 0 No <br /> COMMENTS:(Include code discrepancies,persons present,etc.) <br /> N O S-ku.c,-lu re be W c.0 o n -4-1/\-k. ?ar(c.t ck,-E -4-kQ -2 nkt. (Ss 'i nS fe.C—i;Dfn <br /> Plan revision required? 0 YesWNo 5 15 N23 - l5(Q5(Q- 1 I <br /> Use other side for additional inform n. <br /> Date POWTS Inspector's Signature License Number <br /> SRfl- 71n/R n3/711 <br />