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Perrnil Issued To: ......... ~.taiAl,~;~_t~rl'l ................ Properly Addre~ <br /> Bldr: Dale Boese 362-5726 <br />Septic tc, nk,. Minimum liquid capacity with distributio,~ box ~"/~"~.,J(~'/ Gels, <br /> <br />Subsurface Disposal Fie,~ r~ired_.~_~ Lin, ft '~ '''/ Width of trench __ sq. fl__ <br />t.ot survey ......... <br />Other r eq ui r e m e nt s,,~/'-r/_D/j ~:L_~- <br /> <br />issued <br /> <br /> Rccord Of Individual Sewage Disposal System <br />To Be Completed by Installer <br />INSTALLE~S NAME.~.LJ~- 'F,~ .~JF-¢-,'~( C' ~-~'vv,'~"tz-Phone No..~/%.'~" '~_~.~2..3'J Address ~/,r'~ ~.. ,h,t~'~ z-.~''''~ <br />fetal number: Living unils ____~ ....... Redr'ooms ,~___.__Boths '~-- Basenlenh Yes ~] No <br />Water supply: Public system ,Individual well ~'___ <br />Septic tank: Distance from well.____~(2__O. ............ feet. Materiel . <br /> Total liquid capaclty ~ff_~). gal. Inside length ~0 <br /> Diameter __.ft. Liquid depth <br />Tile disposal field: Distribution box? Yes ~ No k~ Other <br />Length of ectch line__ I00 <br />total length of all lines '~'- .,~',.~O o Ct, Distance from; <br />Widlh of trench ......... "D~'-" ft. Well .............. Ct, <br />Total square footage __,Ct, Nearest <br />Distance between lines /,,~'~ <br /> Ct, Lot line: Front[~ Side~ Rear~ <br /> Foundation fh <br />Type of filter material:°verIiGrovehl'-~"~ ~~ Other Depth beneath tile <br />Depth of filter material e ~ inches, Depth of tile below oripinol ground surface <br /> <br />,Community system ............... <br /> No, of comportme,'ds ................. <br /> ft. inside width <br /> ft. <br /> <br />h~chccs <br /> <br />;ketch of installation. <br /> <br /> N r._,,, V <br /> <br /> ~IARIOH <br />DEPAR, I h <br /> <br />Note: Indlcale Northerly direclion. <br /> h~spec, tion will not be made until completed farm is returned to the Health, Oeph <br /> <br />System apparently will ~-~not [] <br />Remarks .................. <br /> <br />function satisfactorily, and is therefore approved ~"---JD-isapproved J..I <br /> <br />Copies: (]) Orig, HD Files <br /> <br /> <br />