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P SURV f C ES, INC. • 743-4-M-1 2( <br />CITY OF d ✓t/'Y"�t <br />WORKSHEET FOR SEWAGE DISPOSAL WORK <br />41141�.�1)�1n 0� ! ��:fY►►iLr. �yf'.rn Building <br />Date -/---_ ,C) <br />Permit No. 26OV" 003s; <br />Fee <br />Property Address�� S� LAI-eS+ )3" "cA, W of Building <br />— <br />Plumbing � <br />3 <br />Plumbing Contractor -Outside Sewage Disposal AL14 <br />Septic Tanks <br />Material ClMGYL C�i'1,�lh.-- Capacities" <br />Proper Outlet & Inlet? Baffle Plates? — <br />Drain Field: <br />r <br />Total length of lines% Number of lines 3 <br />Type of soil �lr.G— Percolation Test <br />Width of trench Type of filter material <br />Amount of filter material below line <br />Depth from top of tile to finished grade <br />Check Vents >f Check Caulking •—✓� <br />Check Grade in Horizontal Waste Pipes �~ Clean Outs <br />Tonage or Yards of Filter Material ItgOU64.5, Total Sq. Footage of Drain Field Y/0 <br />Sand x Rock <br />Overall Size of Mound System N5 Size of Mound System Rock Filter Material i -- <br />Draw detailed diagram to scale with measurements below. <br />4: L V, <br />1 <br />1't;'yr I <br />