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10-2, (Trir. ~ ~ ~ ~ '
<br />o~te ................... ,.--.g~ ................................................... ~ ~ ~., ~ ~/'~ ~ ~ .~. . ...............................................
<br />~t ~,ue~ T~:..~on~i..~,...Bo.h~.~.~ .............. ~o~r,y A~6 ,~..~'...~.,.~,,,-,~ ............
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<br />................................... .................................................................................................................................. ....................................
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<br /> RECORD OF INDIVIDUAL S~AGE DISPOSAL SYSTEM
<br /> TO ~ GOMPL~b ~YI~A~I STA ...~.~.,~'.,~...~&].,~.~.6~...~,,,,,,~,.~' ' '
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<br /> To?=1 number: Livin~ anf~ .............. ~.~.~ .......................... ~d~ms ........................................................
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<br /> W~ter supply: P~bli~ system ~ IBdiv~l well ~ Community ~ystom ~
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<br /> Septic tank: Distance from well .....~.~.~.........ft M~ter~l .............................................................................................................
<br /> Total liquid capacity ,.,..~ .............. qals,
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<br />To~e~I lonqth cf all lines .......... ,,~..,~.,.~ .......... ft,
<br />Width of trench .................. ~,..~,, ................................... ~
<br />Diston¢o between lines .............. ,/.~, ........................ ti,
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<br />CLEAN NO. 2
<br />Depth under tile ............ :~,, ................... inches.
<br />Depth over tile ............ ~ .................. i~hes,
<br />Depth of tile
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<br /> Sketch of
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<br />Well ........................................ ft.
<br />Ne,:n'est:
<br />Lot line: Front [] Side
<br />Foundation ........................................
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<br />Rear [] ............................ ii,
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<br /> · 0~ ~ D~T, ~)
<br />Sy,tem app.rently will ~. willno, ~ ,unction.ti,~orily, and l~ t~refore ~ppmved~ Disapproved :
<br />Rom~rk~ ........................................................................................ ' ....................................................................................................................................................................
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