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CITY OF UNIEPEAtiNgsM <br /> WORKSHEET FOR SEWAGE DISPOSAL WORK <br /> // / Date <br /> "<<`l <br /> P 1 , — I ' C 7 <br /> Inspector /L C,/hh_> Building Permit No. <br /> Owner (.#4.12-) LJ 1 V--z✓-•--r: Fee <br /> Property Address ;VI-0 '--( i ah L a►lr Kind of Building S Fb <br /> Plumbing Contractor-Outside Sewage Disposal/ J <br /> )CUjLS S�hS LXL- <br /> Septic Tanks <br /> Material (2,1�1LY't`f'� ` 04Yw'rs.) Capacities tbcL% <br /> Proper Outlet & Inlet? Baffle Plates? <br /> Drain Field: <br /> : <br /> ae. / :, <br /> Total length of lines S / Number of lines .3 <br /> Type of soil /3/1-i.' <br /> t:dG Percolation Test S• f• TTS-S•tc r�1 <br /> Width of trench Type of filter material (' -z: 6' L-- <br /> i' <br /> Amount of filter material below line I 'F3 504-tea..( <br /> Depth from top of tile to finished grade <br /> Check Vents Check Caulking "� <br /> Check Grade in Horizontal Waste Pipes Clean Outs �....---- <br /> Tonage or Yards of Filter Material I g0 7 4 va 5 Total Sq. Footage of Drain Field <br /> Sand 1Z-1 X 47 Rock iC 'X iii <br /> Overall Size of Mound System � )4 " Size of Mound System Rock Filter Material , /L <br /> � y Z.. r <br /> Draw detailed diagram to scale with measurements below. <br /> A ( - 3' ; Ai <br /> 3 r s--t; � S <br /> 2 = 77 .4 <br /> 3 : <br /> Fy,/'k e i-4-/Cy let rL. h-+ <br />