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lofeoeuo <br />WORKSHEET FOR SEWAGE DISPOSAL WORK <br />j <br />DateM- Q/ <br />Inspector- f� Building Permit No. <br />Owner1::p V®'V!4 !V &_ 3 Fee <br />Property Address..14f� MtLtu'yC L AVX xx- . Kind of <br />Plumbing Contractor -Outside Sewage Disposal- `MW4'r-% s!- '101--) /-t ]4 - <br />Septic Tanks <br />Material tyt'rs`�'�"z ` �� g�' Capacities 3-1000 <br />Proper Outlet & inlet? �� Baffle Plates?�i <br />Drain Field: <br />cf <br />Total length of lines. • �7- Number of lines <br />Type of soil F2 1 e, o-� Percolation Test <br />Width of trench Type of filter material &tL) <br />Amount of filter material below line <br />�i, e -n AJ U <br />Depth from top of the to finished grade 3 kL f <br />Check Vents -/' Check Caulking— <br />Check <br />aulking Check Grade in Horizontal Waste Pipes Clean Outs <br />Tonage or Yards of Filter Material�6164400QTotal Sq. Footage of Drain Field <br />Sand go, -\(" 1 d iI <br />Rock 1 r7 � � '�{� <br />f f <br />Overall Size of Mound System Size of Mound System Rock Filter Material_ <br />Draw detailed diagram to scale with measurements below. <br />I <br />w �i3 A) t � <br />2ut(ur- j A,P <br />KEW Cove- l( <br />PU, <br />