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L� CITY OF <br />WORKSHEET FOR SEWAGE DISPOSAL WORK <br />f <br />Data <br />Inspector tg,p'� I � Lt- ° �4 Building Permit No. 0 �� e9v ,,7 - <br />Owner lam' i''��d�aPr ta^�f —Z Fee€1�►'�� <br />Property Address/� .,#0-0riind of Building <br />Plumbing Contractor -Outside Sewage Disposal �— <br />Septic Tanks���� <br />Material CCy7AC%i^r_1+4t' Capacities <br />Proper Outlet &Inlet? � <br />.�— Baffle Plates? <br />Drain Field: <br />Total length of lines 41? Number of lines <br />Type of soil i0� [4".Lv-- Percolation Test <br />Width of trench ~ Type of filter material vtx_ �— <br />Amount of filter material below line t7 °i 4--7. <br />Depth from top of tile to finished grade ` <br />Check Vents &I-.— Check Caulking <br />Check Grade in Horizontal Waste Pipes —Clean Outs <br />Tonage or Yards of Filter Material Total Sq. Footage of Drain Field�� <br />Sand ` ° o r x '? 0 Rock TO 1'4 <br />or <br />Overall Size of Mound System '' f5� Size of Mound System Rock Filter Materially <br />Draw detailed diagram to scale with measurements below. <br />C___ � <br />xevs <br />--- <br />Piri{p �! • �� <br />v <br />(QC- 571 &104J 1 j <br />f`,A-P w%e;,(k.-M <br />