Laserfiche WebLink
sae rir%\ <br /> Private Onsite Wastewater Treatment$ County <br /> Ps ,.� Systems ( POWTS) Inspection Report <br /> (Attach to Permit) Sanitary Permit No: <br /> Industry Services Division SAN-23-241 <br /> General Information <br /> Personal infonnation you provide may be used for secondary u oses Privacy Law,s. 15.04 1 m <br /> Permit Holder's Name: Lj City Lj Village x Town of: State Plan Transaction ID#: <br /> Jeremy Baars Jackson 656830 <br /> CST BM Elev: Insp BM Elev: BM Description: Parcel Tax No: <br /> Nail in 10" pine 6313 <br /> Tank Information setback to: <br /> TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road <br /> Septic Infiltrator 1060 +2' NA 64' N/A <br /> Dosing N/A <br /> Aeration N/A <br /> Holding <br /> Pump/Siphon Information Elevation Data <br /> Pump Manufacturer Pump Model Demand STATION BS HI FS ELEV <br /> Filter Manufacturer Filter Model GPM Benchmark -1.05 98.95 100 <br /> Polylok PL-122 <br /> TDH Lift Friction Loss Head Total Bldg.Sewer <br /> Forcemain Length Dia Dist.To Well Tank Inlet 5.87 93.08 <br /> Tank Outlet 6.02 92.93 <br /> Dispersal Cell Information Dose Tank Inlet <br /> DIMENSIONS Width Length #of Cells Dose Tank Bottom <br /> s' rz' 1 <br /> SETBACK FROM Prop.Line Building Well OHWM Inst.Contour <br /> +5' 84' NA NA <br /> Header/Manifold <br /> Type of Cell Manufacturer: <br /> Distribution Pipe 6.42 92.53 <br /> Rock & Pipe Model Number: Infiltrative Surface 7.25 91.7 <br /> Pretreatment Unit Final Grade <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 ❑Yes ❑No <br /> Soil Cover <br /> Mulched <br /> Depth Over Depth Over Depth of Seeded Sodded <br /> Cell Center Cell Edges To soil ElYes ❑No ❑Yes 13 No <br /> COMMENTS:(Include code discrepancies,persons present,etc.) <br /> ws�&w ?" plan . <br /> No well at the time of inspection. <br /> Plan revision required? ❑Yes 17 No 11 13 2023 1565671 <br /> Use other side for additional information. <br /> 1 __] <br /> Date POWTS Inspector's Signature License Number <br /> SBD-6710(R.03/21) <br />