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CITY OF
WORKSHEET FOR SEWAGE DISPOSAL WORK
Date r
,l Building Permit No."200!3 ® 1D C) iL0
Plumbing Contractor -Outside Sewage Disposal
Fee
Kind
Kind of Building
Septic Tanks
Material NVICV` 4_e_ Capacities
Proper Outlet & Inlet? Baffle Plates?
Drain Field:
Total length of linesy Number of lines
Type of soilCQ t 0. e% jt Percolation Test
Width of trench r Type of filter material
Amount of filter material below line'— t4ti
Depth from top of tile to finished grade
Check Vents Check Caulking+
Check Grade in Horizontal Waste Pipes Clean Outs
Tonage or Yards of Filter Material 202'34 Total Sq. Footage of Drain Field
Sand Rock Q I 0'
Overall Size of Mound System 13« Size of Mound System Rock Filter Material r�
Draw detailed diagram to scale with measurements below.
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