HomeMy WebLinkAboutSeptic As Built 07/21/2010 09:56 9524473982 KLINGBERG PAGE 01
x : X49 - tit'1to // iAo
INDIVIDUAL SEWAGE TREATMENT SYS EM AS-BUILT FORM
INSTALLER: et
City/Twp, Date of Installation 7'-'c Q 7t Permit No. o/O —__663-1/42.,
_
Owner G..+" Installed for($ Bedrooms or gpd) ,S'"
Project Address i� '
City 0r441J0 -
WlEW 0 REPLACE 0 REPAIR 0 ADDITION
SETBACKS: • TRENCHES,BED OR GRAVELLESS LEACHFIELD:
Buildings to Tank b Drop box concrete t plastic
Buildings to Drainfield �ae Trench Depth Width
Weli(s)setback 50' or 100' 470 not installed Trench Lengths , /no
Distance to Lake ----Creek '--Wetland Trench'Bottom Level_ yes
Property Line(s)_ g Trench Spacing 1 --
, Drainfield Rock Below Pipe
SEPTIC/HOLDING TANK(S) Ld New ❑ Existing' or Size of Gravelless Pipe
Liquid Capacity . 'Ann (a- /.S®o' ` Actual/EXpected Depth of Backfill
Tank Manufacturer_ - t) -Ga 4aj /Awl> Absorption Area: Square Feet
Baffle Type: Plastic Fiberglass Sanitary-T Concrete Lineal Feet
No, of Inspection es4"!6'�diam., 1 ',,
No. & Dian of Manhole Access L_ T �y� ; ;PUMP INFO;
No. & Height of Manhole Risers S""-. ' w Liquid Capacity /��0
Tanks 4 ft or less below Final Grade �y no : Tank Manufacturer ria` rlc existing
lank Connections Sealed no No. &Height of Risers
Tank/Riser Covers Sealed or above water fable a no Pump Manuf. &Model No. Cc G �
MOUND OR ATGRADE: Feet of ead_ aaei
Percent Slope _ / a' ` °/Q Cycles Per Day '
Dike Width If _up 4 down / 7 side Gallons Per Cycle, 124 5"
Drainfield Rock Below Pipe • I inches Size of Discharge Line es
Inches of Sand Below Rocky .. upslope downslope ; Type of Electrical Figokup o-B,pix b
Perforation Size & Spacing Alarm.Location;- /6,It—' garage • = '+
Pipe Size and Spacing _Jig. '3 ' Alarm:Tank Alert/ veI Alarm IO
Dimensions of Rock Bed l� X eeO,� ! Cycle Counter&Water Meter tnercial)
Dimensions of Sand Base Si le Q! ,
Depth of Final Cover, !le
iii4isvoetkircoo i-c
IT
DRAWING OF SYSTEM: „9
1.
4 I` ,
9d, r-- -
0 Olij
al's ` .
PRI I/VI-ra 7Z Act i
_ f.
Comments: _
I hereby certify,athe iclaller.That the Individual sewage I , w C ✓J�l��o �
trealment system was installed In accordance with the Scott company Name , ' - • • 4.--
County Individual/Community Sewage Treatment System , q 5/rj�rf_a
Ordinance No.4. / License Number n " (�/ Phone Number ,i�( *—� �7
Inctalloar's ---,12.02.---AV-1',..C'••,...`.',. 0 Address 1 0 f n; o k /-2._
I