Laserfiche WebLink
REPORT ON INSPECTION OF SANITARY PERMIT # /s" 7).. <br /> (1) Name and Address of Permit Holder Person/Persons at Site (2)Date of Inspection <br /> Chii <br /> Name, Address, License No. of installing plumber Time of Inspection <br /> C . _ z` — _ Z -r : `'"L <br /> (3)INSTALLATION CONSISTS OF: Septic Tank ❑ Seepage Trench ['Dosing Chamber <br /> ❑Seepage Pit laseepage Bed ❑ Holding Tank ❑ Fill System <br /> (4)BENCHMARK: (Permanent reference Point) Describe : <br /> ( >L ei- 6 <br /> Elevation of vertical reference point: //'i Slope at site: ( 4, <br /> (5)MATERIAL AND DEPTH OF SEWER: " l) ?/C- /'C L ,i) , ,z ,e,it, <br /> (6)SEPTIC TANK: Manufacturer: C -�.N 'ite. Liquid Capacity: /,,w <br /> Tank Inlet Elevation: 77 ' 6"� Tank Outlet El ev: 77 `/ r. <br /> # ft to lot or property line: )- /Qv' # ft to well : c - -- <br /> (7)DOSING TANK: Manufactur- • # of •all-etis : <br /> # of gallon pump set for a cycle .. ons ; total capactiy of distribution <br /> lines gallon ; size of . . p head; gallon per minute ; <br /> horsepower ; b . . name of pump an. -: 1 -1 number • <br /> Is the warning device nstalled? EYES ❑NO Wired? N . ❑NO <br /> (8) HOLDING TANK: Manufacture-rte ; # of gallons ; <br /> construction \ ; depth to er ft; If septic tank is <br /> being used are baffles removed? �. ❑ N0; ft from residence; <br /> ft from well ; -rom pr. :-rty line. Type of warning device <br /> Is the warning device inst. ed? ❑ YES NO; Wired? OYES ❑ NO; <br /> Locking device on co .e • : OYES ❑ NO; Diamete e vent and material . <br /> Distance from building to vent <br /> (9) SEEPAGE PIT SIZE: : of pits; f .4aamet6; ft liquid depth; <br /> ft to residence; ft to ft to property line; <br /> ft to ordinary high water mar. a stream; ft to edge of slopes <br /> greater than ; se- ,. .e pit inlet pipe-- -vation ft; bottom of <br /> seepage pit elevation ft. <br /> (10) SEEPAGE BED SIZE: 1g ft width; 9? ft length;pr:+etile depth; <br /> / 36 lineal feet tile; ft to residence; '-- ft to well ; >.5- ft to lot or <br /> property line; JS/ - ft to ordinary high water mark of lake or stream; N,4 ft to edge <br /> of slopes greater than 20% falling away toward lakes, water courses or drainage ditches <br /> Elevation of tank discharge line entering bed 'W_S'd ft. <br /> (11) SEEPAGE TRENCH: Total length of seepage trench ft; width ft; <br /> tile depth ft; .. well ; ordinary high water mark of <br /> lake ar stream; ft to edge of -.. =..- greater than 20% falling away toward lakes , <br /> water courses or drainage ditche evati . •f tank discharge line entering seepage <br /> trench ft. <br /> (12) Has system been installed in area indicated on EH 115? 5YES ❑ NO <br /> (13) Has system been installed in floodway? DYES ANO Floodplain? OYES WO <br /> DILHR-SBD-6095(N.05/80) <br /> Signature of Inspector: G .... ,l ... 4- 357--- /96.& <br />