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:Septic tonal Minimum liquid capacity with distribution box ~). ~al~_ <br /> <br />Subsurface Dt,posal Field r~ulred /~ ~in. ff. ~ ~ Width of'ranch <br />Lot ~urve~ <br />Other requirements: <br /> <br /> ~ ~ ~ iYu'~l~l~l ~.L/UI'~ ! ! ~L I fl ~ I, - 3anl~TlOn 3~CirlCa~10ns <br />Oo,e ~-~n-~l ~ '"0~ Number ~ ~ .,__ <br /> <br /> , ~. ft, <br /> <br /> issued by: ~ <br /> Record Of Individual Sewatge Disposal System <br /> <br /> Total number~ Living unils ~ :,Bedrooms ' Basement~ Yes ~ No~ <br /> Water supply; Publk &y~tem, Indlvidv0l we~ ....... / { ~ommunity &y~lem ,, <br /> Septic tank: Dictate trammell .~ feet.. Materlol ~ . N~. of compartmen,~~ <br /> ToloJ liquid capocily ~ gal Inside length ....... g, inside wldlh. <br /> <br /> Diameter fi_ Liquid~epth <br /> tile dlspo~ol f~e~d; DistributJ~ box? Yes.~o ~ Other ... <br /> Length of e~ch Hne ~ ~ <br /> Tota~ length o~ oll lines / ~ ~ h.. Dlgtance from: <br /> Width ~f trench . . ~ ..... ft. Well /~ .... ft. <br /> ?oral ~uare foot, ge ft. Nearest <br />Distance between lines ..... ~:' ft. LoT line~ Front ~ Side ~ ~ear <br /> Foundotlon~h. <br />TyRe of fll~.r material: Gravelt ~.. Other .... De,th beneath tile. ~ lnchee. <br />Depth of filler muteriol over tile ~..~lnches,, Deplh of tile bel~ original ground surface /~ inches <br /> <br /> Indtcoto Nodheely dlr*~llon. <br /> ~nspec~ion will not be mode until complet~ form is returned ¢o th~ Health. De.t. <br /> <br />Syslem opRorently will ~'~will not [] <br />Remarks <br /> <br /> :Signoture of Inslolier <br /> <br /> IPOR HEALTH ID~F'T. USEt <br /> <br />function soilt, foctorily, and Is therefo~-e approved ~"'"'Disapprc, ved [] <br /> <br />Copies: (I) Or'g, HD Files <br /> <br /> <br />