HomeMy WebLinkAbout030-1070-30-100Xs..rr�n Cerraftimen, of C ...... PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION �ATTACH TO PERMITi
Personal information you provide may e used for seccridary rourdes [Privady Law S 15 04 f I (m;I
TANK INFORMATION ELEVATION DATA
TYPE
mANUFACTURER
CAP4CITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
VVELL
BLDG
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
GPM
Model Number
DH L
Fuction Loss System Head TDH Ft
F'C'Nug in Lam th Dia Dist to Well
SOIL ABSORPTION SYSTEM
STATION
BS
HI
FS
ELEV
Benchmark
Alt BM
Bldg Sewer
Stli Inlet
SUHt Outlet
Dt Inlet
Dt Bottom
Header/Man
Dist Pipe
Bot System
Tinal Grade
St Cover
BEDITRENCH
DIMENSIONS
VVidth
Length
I
No Of Trenches
I
I
PIT DIMENSIONS
Nn Of Pits
I
Inside [)in
I
Liquid Depth
I
SETBACK
INFORMATION
SYSTEM TO
I
BLD3
V'ELL
LAKE,STREAM
I LEACHING
CHAMBER OR
UNIT
J%Iamrfaclurer
Type Of System
i Model Number
Ii I HIt5U I ILIN Zj Y5 I EM
header %Id,if.id
Hele Size
Hd,. Spaning
to � I
il-ength
lCistrin,ton
P pei s)
D11_
Length Dia Spacing
ZSL)IL L;L)Vt--K x Pressure Svstem.q OnIv .. Ig1pninind Our At.ii �i e.Ii
0,e�
C.pth Over
Depth of
Seeded S.dded
Mulchdd
IDepth
Bed7rench Center
Bed;Trendh Edges
I
Topsoil
1, '
I j Yes No
Y
COMMENTS: (include code discrepancies, persons present, etc Inspection #1
Location: 1392 FROG POND LN
1 ) All OM Description -
2 t Bldg sewer length =
- amount of cover -
Plan revision RequireV Yes No
Use other side for additional information
SBD-6710 (R 3a7) Date Inseldziors Signature
Inspection #2
No