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CITY OF INIMPENBMCE • ( - c
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WORKSHEET FOR SEWAGE DISPOSAL WORK
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Date / - Z_o l ( rt
Inspector LO N I (k Q ( k 135 Building Permit No.
Owner 0,h r j S 15 i u rr. 4.,v"-- Fee
Property Address ' '7 S- F K incl br Bui d ng S F
Plumbing Contractor-Outside Sewage Disposal .A-(4P c5 ±Sc i'� ,
Septic Tanks
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Material C�� (b4 ) Capacities
Proper Outlet & Inlet? 'l- Baffle Plates?
Drain Field:
Total length of lines- Number of lines
i;3 Type of soil (C�-G� Percolation Test 'S : P , ��-S '"j
Width of trench Type of filter material C3 o 81,,i
Amount of filter material below line I 1 1 r—seC�-'fi s R N
Depth from top of tile to finished grade Li 172--
Check
yCheck Vents ✓ Check Caulking zi
Check Grade in Horizontal Waste Pipes '� Clean Outs sr--
Tonage or Yards of Filter Material
s�2.-5 d_+�4y4R5 Total Sq. Footage of Drain Field `7i(C)
Sand Li `S- il3 Rock / u X /
Overall Size of Mound System j 0 X 4.1 Size of Mound System Rock Filter Material � /
Draw detailed diagram to scale with measurements below.
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