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Inspector <br />Owner_ <br />Property Ad <br />CITY OF <br />WORKSHEET FOR SEWAGE DISPOSAL WORK <br />Date r <br />,l Building Permit No."200!3 ® 1D C) iL0 <br />Plumbing Contractor -Outside Sewage Disposal <br />Fee <br />Kind <br />Kind of Building <br />Septic Tanks <br />Material NVICV` 4_e_ Capacities <br />Proper Outlet & Inlet? Baffle Plates? <br />Drain Field: <br />Total length of linesy Number of lines <br />Type of soilCQ t 0. e% jt Percolation Test <br />Width of trench r Type of filter material <br />Amount of filter material below line'— t4ti <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 202'34 Total Sq. Footage of Drain Field <br />Sand Rock Q I 0' <br />Overall Size of Mound System 13« Size of Mound System Rock Filter Material r� <br />Draw detailed diagram to scale with measurements below. <br />S <br />•y <br />A <br />IC, ter. ►VN <br />