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<br /> - '-' FEB 16 2022 .:,- ...
<br /> navElo"IENT ,..„,
<br /> MAR'UN conmi.,
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<br /> ,;... BUILDING INSPECTION
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<br /> EXISTING SEPTIC SYSTEM DESCRIPTION
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<br /> Please answer the following questions as completely as possible,and to the best of your knowledge.
<br /> 1. yov,,o..irdng septic systemco4sists of(check all that apply):
<br /> ,4 ; Ulleptic Tank I.Uxli isposal Trenches 0 Capping Fill 0 Sand.filter
<br /> E3 Seepage Bed 0 Cesspool or Pit 0 Unialown ..
<br /> E3 Other (Describe)
<br /> 2. When.was your septic system installed?
<br /> LUJ2 010
<br /> , ., rfroN ah=ritlituriatz) .-
<br /> material: 0 Concrete El Steel lactic or Fiberglass 0 Unknown
<br /> 4. Septic toTdc volume(in gallons) I 000 ..
<br /> : 1.1 5. When was the septic'tank,last pumped? 1461 Attach receipt if available.
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<br /> li 6. Number of disposal trenches L./
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<br /> ti. 7. Total length of disposal trenches(in feet)
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<br /> 8. Do you propose to use the existing septic system? Yes 0 No4
<br /> , 1 9. Is your septic system currently in u.se? Yes 0 No.A.If no,date of last use
<br /> 10. If the septic system currently serves a dwelling:
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<br /> I How many bedrooms are in the dwelling? ,,,,,all How many people occupy the dwelling? tAL‘..
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<br /> , 11. How many bedrooms will be in the proposed dwelling? How many occupants?- lAci,
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<br /> 12. If the septic system serves a business:
<br /> 1 How many total employees are there?
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<br /> Type of business
<br /> 13. Is there a proposed change of use of your structure(home or business)? Yes 0 No 0
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<br /> f: ,t If yes,please explain
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<br /> 14. Provide a plot plan(sketch)on the reverse side of this form showing the best estinisted or actual
<br /> measurements that locate the existing septic tank and disposal trenches,property lines,easements,
<br /> 1 existing structures,driveways,and water supply.Indicate the direction of north.If you are proposing to
<br /> replace the septic system,indicate the test hole location.
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<br /> By my signature,I certify that the above information and the plot plan on the reverse side of this forte are
<br /> accurate and true to the best of my knowledge.
<br /> 1 ,,offtverty Own=a LtipIty -or=uace. "-----T----
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<br /> Office use only:Record of=Elvin system:'Yes 0 No 0 Mocked 0 Datel=nerl
<br /> PeanirNumber Cortificare of Satisfactory Completion booed: Y=0 No6- Inkieli
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