HomeMy WebLinkAboutSeptic As Built N
O
CITY OF isig ism .
MID Orono 1.1111.1• MN TOa
g?
p ,, o X
Location of job �r) \-,U``Q+`G ` o
Y a
Owner %J Jt \-\4.t„Z'S !Address i2,.
Licensed Designer S.C.” —re.0- .r.tS Sr. . . License# (a 21
Licensed Installer -C.,-.: s'N$ S-e_ . (Y License# `( i A
Signature
Date 11/1-tofl3
(Show location of house, tank, drainfield, property line and well)
N
�1`w
vv._
_F E
I
k '
,� �t � �
; f
,/7R� �f
(01
1
, T
n
, I
,t r___________ ) ei 0 4 jill'
L........, -..f4,1,. . , ,......... .... -0
,.;,,,,..„ ,
``"m.„
NOTE: On ALL replacements and additions, tanks must be exposed for baffle inspection.
COMMENTS: .iA." - v.,1 a(f " t 2 11 o a-- c.43-- 1'Y \-\o" s-Q At) -let
New Work A Outside Lift ji
Replacement ❑ Ejector ❑
Addition ❑ Gravity ❑
Mound System;it'
Tank Size 3 -- 2ei4
0 DATE -
Tank Size INSPECTOR
Square Footage of Drainfield Area 650
Depth of Rock Under Pipe '"f" COMMENTS
Depth of Rock Over Pipe 2''
Graveless `�
Depth of Dirt Cover 1 g`,
Number of Bedrooms 5 c 'y'
THIS FORM MUST BE FILLED OUT BY A LICENSED INSTALLER (ASBUILT)
(l)CITY COPY, (2) OWNER COPY, (3) LICENSED INSTALLER COPY