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<br /> INDIViDUAL SEWAGE TREATMENT.SI.STE,M.A .1ILD FORM
<br /> INSTAi�.LER:s� ,: . ,,,�� ...P'j4,,,L,„...774.<____�
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<br /> TOWNSHIP ___DATE QQF INSTALLATION_Q��.Qi O `PERMIT NUMBER a '^ �� !
<br /> OWNER olio-5® G� !i - --- _
<br /> _.��..�.:....,. . .. �..,� ,... 1. ._. •�: ... �_�.
<br /> PRO.IECT DORESs� ., ,. ,!d.,.. ,1s. _
<br /> CITY /1�jaam__-- ----_-__, ,....—21 CODE - ,y_0 NEW ( iMPLACEMENT ❑ REPAIR
<br /> SE['BACKS: IRE , HES, B1.7,O3 OFt GRA►OEL.t EIS I.IACHFIELD:
<br /> t g '/vy _ "F rj .�ibution Box 1.�� Drop box
<br /> Buildings to drak fi�.,., o Trenc 'j Depth _,.. __.. . .
<br /> Woll(s)$0'or iLs' _ Trbn' 'Length
<br /> take/Creek e and __ _�. ..,__ Trenc Width .............. _
<br /> Piaperty Lines_.,__.__ /n`,_ ..._____-�.__.—_ Trenc -Bottom Level ,__,_,___._-..__._._-.• ,
<br /> Irene ]Spacing_,-----
<br /> SEPTIC/HOLDIteIG TANKS 'NCW ❑ Existing Drain elii•Rbt;k below pipe.... .... ..... ... . ...._- _
<br /> Liquid Capacity To (rtil �. `Slz f pravelless pie .._._,Manufacturer type .O.J.,A_l ._,.._- - --_ Depth f Sackful_ '%Type of baffle (1-e tglass)______.,_•,,_____-- AbsOr ,ion Area: square feet....-_...— -,_ .
<br /> No.& Size of Inspec'' pipes �_. _ 'llneei feet _�,,.,.•,-_•-_ „
<br /> No. &Size of Manhole access
<br /> No. & Height of risers . ! PUMP :
<br /> Tank pedty 2'n1 L�'er-t40•� /ePee , l
<br /> [MOUNDS: Tank r arn,facturer& Ty' II 9 ?t�
<br /> Percent slope.� . .... .7_ .., .,, . ....,..,__.,1� No. 8 ",ieight of risers t --
<br /> Upslope dike width_ Pump anufacturer&Mo e►No. /.WyQ/i
<br /> Downsiope dike width y.� Horse ower& GPM •
<br /> �,V f
<br /> Sideslope dike width --..._. .- 1,, ...__ .._. . . ,,._ Feet Q head. —.441.0. 7,' .. Di
<br /> Oriinfield rock below pipe _,.,.,_._._.....,,, ......._.,. Cycles per day --��, ' _
<br /> Depth of sand below rock�Q"'� upsia ,___Ownsiope Gall per cycle_�'
<br /> Porforetion size &spacing 7!�__!_„__•_,__ ___. Size o ischarge line ___:...A,'�
<br /> Pipe size end spacing....:A7 ' _ Type o electrical hookup
<br /> Dimensions of rock bed__I , _^_^-• ,�_ Type e .d location o`eierin.2" ,�,,L�
<br /> Dimensions of sand base_,,,,_ x_Zcl��--__.___ Cycle • unter(commercial) ,_., ./A
<br /> Final Cover,.._ ,......./L..4... -.... .,
<br /> DRAWING OFSYSTEM
<br /> I Ztro.•••••(
<br /> l'i , r„t,f,, 0 b•"L.
<br /> el) /
<br /> 41.. .. 10
<br /> spy
<br /> �714>nif i I 7
<br /> �Z.N as0 --�'_
<br /> A�l44 ...
<br /> 1----1
<br /> 1De— itee. 1L..,_________.
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<br /> Comments_.. / ens. 'u`.. V e- q'..... r y eOn
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<br /> t h'rr,py G9rlify.ate trm inur.mgr,that tltic individual eev✓ape treatnu nl system was r n. iemai4,46,J „6il4.,.,, yl�� License C ,,,- g 9
<br /> rnyt�aW in occddenvWu
<br /> ce with The Scott Courtly rntliai Sewage'rreotmenr 5ys'em .' >�
<br /> Ordinance No.s. I agree to Indur^ruPy and save Scott County harmttice from all 4co ss„ f`��,.3 � � r IG__Y. ,
<br /> lose,damages,cools,end charges at nay be hxurr 4 by tho County because or
<br /> my(allure to conform to and nip Mth the provisions of Inis Girth• .co'. ... ...iy/t/ 3 _ 2
<br /> in:a:,;te�.'e 3lyrwture_. 7 a �5- • '_r. . — J,.. `�"
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