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450 Willow Dr S <br />CITY OF - 91 E • (763)479-&52-7---- <br />WORKSHEET <br />7f3)- <br />WORKSHEET FOR SEWAGE DISPOSAL WORK <br />Date <br />11 <br />Inspector1/Z �l ? �n% Building Permit No. <br />Owner - ► 11 �� 4% v� f� Fee <br />Property Address 9 AJ _D f' SKind of Building 5 <br />Plumbing Contractor -Outside Sewage Disposal 0 -nty -e <br />Septic Tanks / <br />Material 6712K t'_ -47# - I DAV" ' � Capacities :3 �) 0��' <br />Proper Outlet & Inlet? i Baffle Plates? <br />Drain Field: <br />Total length of lines Number of lines <br />. _-;p . z <br />Type of soil G;_Percolation Test u c, k tL-,tLA <br />Width of trench Type of filter material^L <br />r� <br />Amount of filter material below line A! uln <br />Depth from top of tile to finished grade <br />Check Vents ✓' <br />Check Grade in Horizontal Waste Pipes <br />Check Caulking <br />Clean Outs <br />Tonage or Yards of Filter Material 7 L `Z"" S'f`(Total Sq. Footage of Drain Field V6) 6 <br />Sand Rock <br />Overall Size of d System Size of Mound System Rock Filter Material <br />Draw detailed diagram to scale with measurements below. <br />R Lo <br />a"A�5�1� <br />�t <br />I. <br />3 <br />-ia V1 k.5 cL >"d <br />