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COUNP1c PERMIT i <br /> �jSANITARY INSPECTION REPORT <br /> Owner's . ll , a�' 9-d Location <br /> Addrws <br /> State Permit Installer <br /> SEPTIC TAN( <br /> /' <br /> ;eptic 71M* ✓ 1btal Cellons 7Sb Hiner of Tanks l <br /> lding Tank Total Gallons Number of 'Dir" <br /> terial: Concreted Steel 1,-' FibeMlaw. <br /> t PiPi.ng to & frrom Tank <br /> Inlet Leaded: Yes <br /> Outlet Leaded: Yea No <br /> Sealed Properly: Yes NO <br /> Unk Appears Level: Yea t/" NO cev <br /> ONLY: <br /> warning Device <br /> es <br /> Looking Device: Yes No <br /> DRAINFIELD <br /> b3orption Bed: Length width Depth 36 -X1.2 <br /> boorption Trench: Linear Ft. width Dep j - <br /> ftsorption, Pit: Depth --'InsidgDiambt�er <br /> it Appears as in EH-115: Yes �ib Ex <br /> Vlain: <br /> tante to Bldg, 17 well <br /> Aggreggate 3/4 - 2-1l2 Inch: Yes ✓ No <br /> 12 Inches Below Tile: Yes`i/ W- <br /> 2 Inches Above Tile: Yee = No <br /> Covering: Building Paper Marsh Hay l� <br /> Vent Pipe Minimum 4^ C.I.: Yes (G No <br /> AS-BMLT SAME AS APPLICATION: Yes ✓No • <br /> M If As- It differs from system shown on PL$67, draw a diagram of the system as <br /> built on the reverse side of this report. <br /> INSPEI.'TOR <br /> DATE 6- 3(9-� <br />