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CITY OF INDEPENDENCE • (763) 479-0527 <br /> WORKSHEET FOR SEWAGE DISPOSAL WORK <br /> Date 1/ <br /> Inspector LO/// 2 Building Permit No. 7,040f v4473 <br /> Owner ] L1Os6r,,eS &WS,--- /� � Fee <br /> Z ' ` <br /> Property Address �'r /Lei" —`��Kind of Building S�� <br /> Plumbing Contractor-Outside Sewage Disposal I-4 _S 71" s0"^-3 <br /> Septic Tanks <br /> Material C i Capacities 3 `.-s <br /> Proper Outlet & Inlet? `� Baffle Plates? <br /> Drain Field: <br /> / <br /> Total length of lines CD" Number of lines 3 <br /> Type of soil /J tea/Lc Percolation Test 12---4-'517 t? 5 <br /> Width of trench Type of filter material -CJ io"'1‘-z— <br /> Amount of filter material below line /Z 504"", <br /> 3ri-z_ <br /> Depth from top of tile to finished grade <br /> Check Vents ✓ Check Caulking <br /> Check Grade in Horizontal Waste Pipes " Clean Outs <br /> Tonage or Yards of Filter Material 2-47-0 71412 Total Sq. Footage of Drain Field G0 30 <br /> Sand 1/ X R3 Rock / fl X- 63 <br /> Overall Size of Mound System /S 7 k7 Size of Mound System Rock Filter Material <br /> Draw detailed diagram to scale with measurements below. <br /> • <br /> 4 <br /> ,41 T2s" <br /> -2,- 3S3 &L7 <br />