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CITY OF <br />WORKSHEET FOR SEWAGE DISPOSAL WORK <br />Date <br />Inspector `/ A5 <br />P Building Permit No. <br />Owner �� , ' 4-,. �13 L,-_5-("✓ <br />i Fee <br />Property Address t ��' �- `�ceK d o Building � <br />Plumbing Contractor -Outside Sewage Disposal y GS S <br />Septic Tanks .Q��zS��rL�5 <br />Material' ' �"� -Capacities�w r`h <br />Proper Outlet & inlet? ✓— Baffle Plates? - <br />Drain Field: — Z-5- <br />Total <br />STotal length of lines-,,'--) Number of lines `3 <br />Type of soil 10 C—A- Percolation Test- <br />Width <br />est Width of trench Type of filter material__ 64a �f/t <br />Amount of filter material below line 12-41 1 "'1 <br />a <br />Depth from top of tile to finished grade 3 VL, <br />Check Vents Check Caulking <br />Check Grade in Horizontal Waste Pipes d Clean Outs <br />Tonage or Yards of Filter Material Total Sq. Footage of Drain Field - <br />Sand—_ <br />Sand e Rock Z /d k Z!!� � <br />Overall Size of Mound System Size of Mound System Rock Filter Material_ <br />Draw detailed diagram to scale with measurements below. <br />