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HomeMy WebLinkAboutSeptic As BuiltINDIVIDUAL SEWAGE TREATMENT SYSTEM AS -BUILT FORM INSTALLER: goHK WUL ba tt_t_ fK(;r eD. City/Twp._Oyu yi0 Date of Installation 10-1LI-W Permit No..20)0 , 605'72.) Owner Installed for (# Bedrooms or gpd) Project Address -1 It Wct UYtG� OrohD City IN NEW ❑ REPLACE ❑ REPAIR ❑ ADDITION SETBACKS: , Buildings to Tank D Buildings to Drainfield _ y© Well(s) setback 50' or 100' '> i-0(0 not installed Distance to Lake_-- Creek Wetland Property Line(s) Tatti kS i T SEPTIC/HOLDING TANK(S) f New ❑ Existing Liquid CapacityL49Q__ to Tank Manufact Lv� e,se. V"' �_ Baffle Type: Plastic Fiberglass Sanitary -T Concrete No. of inspection apes —" 4" / 6" diam. No. & Diam. of Manhole Access _ y 4y" No. & Height of Manhole Risers yy AR Tanks 4 ft or less below Final Grade y s no Tank Connections Sealed _1kr5f , G roae Fa�, m. a no Tank/Riser Covers Sealed or above wdtef table es no MOUND OR ATGRADE: Percent Slope { 0 Dike Width 9' _up30 downi nside Drainfield Rock Below Pipe __ inches Inches of Sand Below Rock I a upslopesdownslope , Perforation Size & Spacing T/�-e2f��3(� Pipe Size and Spacing _a KD'' cnn Dimensions of Rock Bed 10X&3 Dimensions of Sand Base _ IYX il9 Depth of Final Cover JT' }b Ig" f IePWGI TRENCHES, BED OR GRAVELLESS LEACHFIELD: Dr xconcrete / plastic Trench Depth Width Trench Lengths Trench Bottom Level _ yes / no Trench Spacing Drainfield Rock Below pe or Size of Grave s Pipe Actual / Expe d Depth of Backfill Absorptio rea: Square Feet Lineal Feet PUMP INFO: Liquid Capacity (�V Tank Manufacture~ SAM E _ ,w existing No. & Height of Risers 34" dA Y" Pump Manuf. & Model No. 00U ldy Horsepower. ,fp GPM 3f7 Feet of Head _ �_ty Cycles Per Day :;-L( Gallons Per Cycle __ 1570 Size of Discharge Line " Type of Electrical Hookup post 8. bo t Alarm Locat' gar emen Alarm nk ler /Level Alarm /Other _