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INDIVIDUAL SEWAGE TREATMENT SYSTEM AS -BUILT FORM <br />INSTALLER: goHK WUL ba tt_t_ fK(;r eD. <br />City/Twp._Oyu yi0 Date of Installation 10-1LI-W Permit No..20)0 , 605'72.) <br />Owner Installed for (# Bedrooms or gpd) <br />Project Address -1 It Wct UYtG� OrohD <br />City IN NEW ❑ REPLACE ❑ REPAIR ❑ ADDITION <br />SETBACKS: , <br />Buildings to Tank D <br />Buildings to Drainfield _ y© <br />Well(s) setback 50' or 100' '> i-0(0 not installed <br />Distance to Lake_-- Creek Wetland <br />Property Line(s) Tatti kS i T <br />SEPTIC/HOLDING TANK(S) f New ❑ Existing <br />Liquid CapacityL49Q__ to <br />Tank Manufact Lv� e,se. V"' �_ <br />Baffle Type: Plastic Fiberglass Sanitary -T Concrete <br />No. of inspection apes —" 4" / 6" diam. <br />No. & Diam. of Manhole Access _ y 4y" <br />No. & Height of Manhole Risers yy AR <br />Tanks 4 ft or less below Final Grade y s no <br />Tank Connections Sealed _1kr5f , G roae Fa�, m. a no <br />Tank/Riser Covers Sealed or above wdtef table es no <br />MOUND OR ATGRADE: <br />Percent Slope <br />{ 0 <br />Dike Width 9' _up30 downi <br />nside <br />Drainfield Rock Below Pipe __ <br />inches <br />Inches of Sand Below Rock I a upslopesdownslope , <br />Perforation Size & Spacing T/�-e2f��3(� <br />Pipe Size and Spacing _a KD'' cnn <br />Dimensions of Rock Bed 10X&3 <br />Dimensions of Sand Base _ IYX il9 <br />Depth of Final Cover JT' }b Ig" f <br />IePWGI <br />TRENCHES, BED OR GRAVELLESS LEACHFIELD: <br />Dr xconcrete / plastic <br />Trench Depth Width <br />Trench Lengths <br />Trench Bottom Level _ yes / no <br />Trench Spacing <br />Drainfield Rock Below pe <br />or Size of Grave s Pipe <br />Actual / Expe d Depth of Backfill <br />Absorptio rea: Square Feet <br />Lineal Feet <br />PUMP INFO: <br />Liquid Capacity (�V <br />Tank Manufacture~ SAM E _ ,w existing <br />No. & Height of Risers 34" dA Y" <br />Pump Manuf. & Model No. 00U ldy <br />Horsepower. ,fp GPM 3f7 <br />Feet of Head _ �_ty <br />Cycles Per Day :;-L( <br />Gallons Per Cycle __ 1570 <br />Size of Discharge Line " <br />Type of Electrical Hookup post 8. bo t <br />Alarm Locat' gar emen <br />Alarm nk ler /Level Alarm /Other _ <br />