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CITY OF 0 N // ° <br /> WORKSHEET FOR SEWAGE DISPOSAL WORK (PLUMBING INSPECTION) <br /> Date -2 7—11 <br /> Inspector .0 <br /> Building Permit No. 0 1 1 "'o 1O g <br /> Owner it .;.-ckae / 4 'arcs .$'t•.ei►.So,7 Fee <br /> Property Address 2.`I4S Ot-e-r R..e, TPA.; ( Kind of Building <br /> Plumbing Contractor-Outside Sewage Disposal ( t ! r 3- Pc-tc-'S`Y'1 C®. <br /> Septic Tanks <br /> Material C �` i ''K'��1(11, Capacities <br /> Proper Outlet & Inlet? Baffle Plates? <br /> Drain Field: <br /> Total length of lines Number of lines <br /> Type of soil Percolation Test <br /> Width of trench Type of filter material <br /> Amount of filter material below line <br /> Depth from top of tile to finished grade <br /> Check Vents Check Caulking <br /> Check Grade in Horizontal Waste Pipes Clean Outs V -3 <br /> Tonage or Yards of Filter Material Jo Yv`_Q Total Sq. Fortage of Drain Field 630, <br /> Sand 6-y Rock / <br /> Overall Size of Mound System Size of Mound System Rock Filter Material t� 8. <br /> Draw detailed diagram <br /> ^to scale with measurements below. <br /> 4e_. 10-z 1/CJt T O[e f'��7� Rack dt.d '/l F.--�(',3-4/1?),2 <br /> 3. 12 ©. 3 <br /> LI - 6(43.f?„ <br /> g9.3 90. 6, <br /> qc7 <br /> R <br /> 47 <br /> • <br /> (D <br /> H <br />