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CITY OF U Y-0 YL <br />WORKSHEET FOR SEWAGE DISPOSAL WORK <br />Date (P _ Z-7- O� <br />Inspector to i_ 111,4- c °,L b Building Permit No. <br />Owner 4 e bn " -,j Z %, L_ `' (, °`^ A n1 Fee <br />Property Address i y 50 U e -.-%L F'¢f- ri ` Kind of Building -5 F b <br />Plumbing Contractor -Outside Sewage Disposal <br />Septic Tanks heW p^ rwi J <br />Material ' CapacitiesCoQ' <br />Proper Outlet & Inlet? Baffle Plates? ✓ <br />Drain Field: <br />3 <br />Total length of lines � Number of lines � (" <br />Type of soil -CZ, -Percolation Test <br />Width of trench =�- Type of filter aterial T E;1 (10 <br />Amount of filter material below line 2- �� <br />5 r'f ,Y9 <br />e <br />Depth from top of the to finished grade -2 <br />Check Vents �� Check Caulking-- <br />Check <br />aulking <br />Check Grade in Horizontal Waste Pipes Clean Ou <br />Tonage or Yards of Filter Material °� Zed `] `�s` Total Sq. Footage of Drain Field 3 <br />Sand ® X ` - Rock /0 /x 3 -*-I <br />Overall Size of Mound System Size of Mound System Rock Filter Material �2 <br />Draw detailed diagram to scale with measurements below. <br />-2-0 <br />2- z <br />f <br />ru <br />Pump <br />wr,q16,0_141-1 <br />