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Oate <br /> <br />Saptlc tank: Minimum Ik;lULd ~opactty w~th distribution be,x <br /> <br />Subsurface Disposal Fiald re~ulred~~_ ~L n, fl_ <br /> <br />Other requirements; <br /> <br /> MARIUN LUUN i ¥ HLALi I-[. I)l:,l'J. -3an,tatl0n apecmcanonSNumb., <br /> <br />Bobb~ L. Sh~a~d 949-2407 Prope**tv Addres:~ :l ~SVi~le <br /> <br /> Width of Ir0nch scl,, ~t <br /> <br /> Record Of individual Sewage Disposal System <br />To Be Completed ~'~ .~~/,j~_ _ <br /> <br />Tolal humbert Ltvlr~ units ~/,- ./ Bedrooms__Baths .... Bosemanh Yet [] No <br />Waler supply= Public system = Individual well ~".-"'~ Community system .............. <br />SepHc tonki Distance from weft /~'~' feet. Material .... Z~',~,-': .No. of comportments~ <br /> <br />Total liquid capacUy ."~'/zg~ ,gal, Inside length fl_ inside wldlh <br /> Diameter , it. LIq u~eplh <br />Tile disposal riel& DJstributi~? Yes ~ No ~ther ,, <br />Length ~ each llne ~ . ~ ....... <br /> <br />Yatol ie.gth of oll lines ~--~ fi, Dislance from: <br />Width of trench__ ~'-~ ~ ft. Well <br /> <br />Dislonce baleen IJne~__ __ ft, Lot llne: Front <br /> <br />Type of filler materiel= Grovel: ..~,~,~,~,~,~,~,~., Other Depth beneath lfle .~,. inches. <br />Depth of tiller mate~qoJ over tile . ~., ,. inches. Depth of tile below original ground surface ,"~.~'~'- inches <br /> <br />Inspection will hal be mode unlll completed form <br /> <br />System apparently will/~ <br /> <br />Signature cfi <br /> <br /> tFOR HEALTH OEPT, USE) <br />will not [] fur',etlon solisfo¢~orlty, ond is therefore approved I~'/ <br /> <br />Disapproved ~ <br /> <br />Coplesi Il) Orlg, HO Files <br /> <br /> <br />