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/y <br />'3 9 q o L,-) /).+ er +oW n/ I� (4, <br />219 <br />WORKSHEET FOR SEWAGE DISPOSAL WORK <br />Date <br />InspectorBuilding Permit No. <br />Owner Cy e✓t,��r"�"''i�` Fee <br />Property Addres�'� ���"`'� kind of Building <br />Plumbing Contractor -Outside Sewage Disposal At 'J' <br />Septic Tanks <br />Materials •'q I �` ` Capacities 3 3 C,)0 <br />Proper Outlet & Inlet? ...N Baffle Plates? " <br />Drain Field: <br />Total length of lines �" Number of lines <br />Type of soil_ <br />Width of trench <br />_ Percolation Test <br />Type of filter material <br />Amount of filter material below line <br />Depth from top of tile to finished grade <br />Check VentsCheck Caulking " <br />Check Grade in Horizontal Waste Pipes "' Clean Outs <br />Tonage or Yards of Filter Material Total Sq. Footage of Drain Field `4' `-- <br />Sand Rock 0 )< Z� <br />Overall Size of Mound Systems Size of Mound /System Rock Filter Material 1`2 <br />Draw detailed diagram to scale with measurements below. Gift �.,� X� J-; j .0 <br />�L,2 <br />Aly, <br />11 "�" +A te_� <br />(144/W o, 2— '�e J <br />