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� <br /> a� ` ` �, <br /> .? �L k�• <br /> � CITY OF I - E--s-- <br /> � �-7 <br /> .� <br /> L <br /> s WORKSHEET FOR SEWAGE DISPOSAL WORK <br /> � <br /> � U�� ��I� <br /> � <br /> N Date � <br /> Inspector L-'�--'� d � � r Building Permit No. <br /> Owner (�"'h a v'� �-�'4��x-- � Fee <br /> � � <br /> Property Address�L� ' 4� ���'✓'K���� ���'r Kind of Building � � ,� <br /> Plumbing Contractor-Outside Sewage Disposal �� '✓� � � ` r' I � �� �`'� <br /> Septic Tanks ��S V c.� /�1 <br /> J <br /> Material � � �L✓`C � r�%�� Capacities -��"��.%�� <br /> Proper Outlet & Inlet? Z-�""� Baffle Plates? �''�� <br /> Drain Field: � <br /> Total length of lines �� Number of lines � <br /> Type of soil 1? ��-�� Percolation Test �~ � y t� �i1'� <br /> Width of trench �-- Type of filter material ��'C(- �� E7�`'� <br /> Amount of filter material below line � 2 + + S �4�.�'� <br /> Depth from top of tile to finished grade <br /> �`�i � <br /> Check Vents �" Check Caulking � <br /> Check Grade in Horizontal Waste Pipes �� Clean Outs � <br /> Tonage or Yards of Filter Material i .3�� ��� Total Sq. Footage of Drain Field 7?-✓U <br /> Sand � ( 1` �� - Rock j (,7 1L ��% <br /> .i <br /> Overall Size of Mound System �'� �" �f`� Size of Mound System Rock Filter Material ( r�'L- <br /> Draw detailed diagram to scale with measurements below. <br /> � � �! . - j <br /> W <br /> � v <br /> � � <br /> � � <br /> l7�`��t <br /> ��� t � <br /> � <br /> �''i� � ► = �o � E�1 ��� � <br /> � .� y �. P <br /> z ��� � ;,,�,� ..� � �. ��n�, <br /> � ' �1 <br /> 1� 1 � � 3� �� ���� <br /> , g-y l� <br /> � � <br /> � - ��,' <br /> � <br />