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co PLO njG <br />CITY OF I <br />WORKSHEET FOR SEWAGE DISPOSAL WORK <br />Date "°' `� —, c) <br />Inspector W I I it" A_ Building Permit No. <br />Owner W � It P A ry- U-'% Fee <br />Property Address �f3l(00 (0 A'v-e 'Aj - Kind of Building 5Fb <br />Plumbing Contractor -Outside Sewage Disposal <br />0-3%5 <br />Septic Tanks <br />Materialer�'-� \ _ ��`'�ti''� �'�� Capacities a O'er <br />Proper Outlet & Inlet? ��� Baffle Plates? <br />Drain Field: <br />P <br />Total length of lines �" Number of lines 3 <br />Type of soil L.> 1CL <- Percolation Test <br />Width of trench Type of flit material <br />Amount of filter material below line 12- _%4 <br />Depth from top of tile to finished grade "/L - <br />Check Vents Check Caulking <br />Check Grade in Horizontal Waste Pipes J Clean Outs <br />Tonage or Yards of Filter Material f�y�.�S 5k Total Sq. Footage of Drain Field 391 <br />Sand !!;:-a )< 3j Rock I e)- X-3 g' F <br />Overall Size of Mound System !0U X'4 Size of Mound System Rock Filter Material <br />Draw detailed diagram to scale with measurements below. <br />39 , <br />,5,;, G <br />P; I 4-tv w e, (co ki <br />pts! G""U Qv>M� <br />