Laserfiche WebLink
,,, ..-.......................,5,.w„,::,.....,,,,,,,,,4 _ . , ,. <br /> - -- kIA-..-Fj'ilitiliON c-020u221,41-y-L <br /> t JILDING 1NspEcTio,, <br /> EXISTING SEPTIC SYSTEM DESCRIPTION <br /> „ ,..... <br /> „. <br /> Please answer the following questions as completely as possible,and to the best of your latovviedge. <br /> L Yitpri existing sePtic system consists' of(checlt all that Ce 1 <br /> ed <br /> 0 Disposal Trenches apply): <br /> capp)' ing Fill 0 samdfiltzr <br /> Septic Tank <br /> 0 Seepage B <br /> El sspool or Pit <br /> : ID other (Describe) [3 unknevirt <br /> was Pm sePhc sYstern installed?_____________Vi 4-- , <br /> . , <br /> , t 3. Tank maetial:. IT,J,Kaficres.e <br /> 0 Steel 0 Plastic or Fiberglass 0 Unknown. <br /> • <br /> 4. Septic tank volume(in gallons) <br /> 5- When was the sePtk tank,ListParriPed? \M„,„414._12.— Attch receipt if available. <br /> 6. Number of disposal trendhes_____3_____ <br /> t <br /> 7. Total length of disposal trenches cm feet) <br /> A , <br /> i : 8. Do you.propose to use the existing septic system? Yes EVNo 123 <br /> 1 ' <br /> il <br /> i) 9- Is your septic system currently in use? Yes Ei No Ektriio,date of last use <br /> 10. If the septic systzca currently serves a dwelling <br /> li <br /> g . How many bedrooms are in the dwelling? ow many people occupy the d * ..? - <br /> ________. <br /> • <br /> ti 11. How many bedrooms will be in the proposed dwelling? I How many occupants? <br /> 12. lithe septic system serves a business: <br /> How many total employees axe there? <br /> 0 <br /> n,,, <br /> Type of business <br /> I <br /> 11q: 13. Is there a proposed change of use of your stna-tuLe(home or business)? Yes 0. No i3----- <br /> :4 If yes,please explain <br /> 14. Provide a plotplan(sketch)on the reverse side of this form showing the best estimated Or actual <br /> 11 measurements that locate the existing septic tank and disposal trenches,property lines,easemenz, <br /> 1.4 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. <br /> fl <br /> it <br /> By my signature,I certify that the above infomiation and the plot plan on the reverse side of this form ate <br /> V4 <br /> accurate and true to the best of my knowledge. <br /> 11 <br /> h (3/7 ill4 1._ <br /> tzamansafProperty . .17'''' <br /> Office tat*On Record of=fisting syst=a:Yes 0 No 0 Anaciand 0 Muhl:n=1 <br /> Przatit Number Cc-I:Twat:of Satis5rztari Carapintiaxassand: Yes0 13o0 Initials <br /> iOttar file irfornrstirn. <br />