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a "M�" <br />- <br />Parcelld #: <br />Septic System As -Built Form <br />f� Permit: <br />Installer ��rs--Q �r�i�-� e- <br />Street/City: i"W Fv�v St, d(Wne, rho # of Bedrooms$ 6 Flow Rate (gpd): jRcj 6*jjc;,tjs Z.'Ti;M, <br /># of Septic Tanks: Sizes; Iy;0 I 10 be, I Tank Meg: re * g•• 51! om <br />Pump Tank Size: Tank Mfg: Qrz,tm)r kj%s Model pL, S! <br />Pump Size; i <br />DETAILS: <br />Type I �d Holding Tank Only ❑ Type III ❑ Type IV ❑ Septic Tank Re lacerr❑ <br />Trench ❑ Bed El Mound At Grade ❑ Floats Proper')i = �1 <br />Limiting Layer Depth: 1 �cui� Rockbed Size: i Os*i( (e3 <br />Depth from Rock Depth Sand Depth <br />Surface (h): under pipe (in,): (p) Li <br />nder mound (in.): <br />Z�L <br />Abscrptioi^ <br />Vilidth: 7�d_ <br />Trench /Bed Trench /Bed Bottom Square <br />width (ft.): length (ft.): Ft. Area: <br />1p��j tid baJrx' <br />;3 U, <br />UU V <br />v° <br />5)1h <br />Wit <br />Include these: <br />1. <br />Sept c, <br />3. <br />4, <br />5. <br />6. <br />holding/:l ranks; <br />piping, 'oi' yst�m <br />confiaurpr-• r. label <br />bed rr a•.'- <br />width%iFr,q . ,. <br />rockbed si`^ <br />absorption melth and <br />tinal dim5„sions. <br />?.. Show all seN-backs <br />from tank Pod soil <br />system. [property <br />boundaries. <br />buildings, we!Is, <br />water bodies, road <br />right of -way. <br />Improvements — <br />present anti future. <br />i3enchmark location <br />and distance v tank <br />and soil system from <br />benchmark. <br />Replacement site. <br />Abandoned <br />system(s). <br />I hereby certify that !have completed this work in accordance with applicable ordinances, rules and laws, <br />Installer Sig.: �, ,�� 0 License #: 'La 2�( Date: Z3 <br />