|
, 7 7./
<br />'" MARION COUNTY HEALTH D'E'PT.,.Sanitation Specifications
<br /> DC, m .....6.m16.mT. 3. ...................................................... DUi~'F,]'CA'~R Numbee ..,.~,~.~ ...................................
<br /> ~avi~ L. ~ak~r ~ er .~.!~.~...~.~W~...~.~,...~.~!!~ ......
<br />
<br /> ................. ~ ............. w~:ith al ~rench
<br /> Subsurtace disposal Ileld req~i~e~ ......... .~,O ..................Lm, iL
<br />
<br /> Issued by
<br />.................................................................................................................................................................... ,..~,...gk.a...r...a,...,.3,,,.,.,!~r.,~..n,.~.,,,l,~.l .........................................
<br />
<br /> RECORD OF iNDIVIDUAL SEWAGE DISPOSAL SYSTEM
<br />
<br />INSTALLER'S NAMtll ~.~'~.~..~1~ .......... ~.~.~...... Add~ess .~.1,,.~.,.,~ .............. ~.~....~.~ .......... .-~'...'.~.,.~.,~,,'.........Phone N~,.~.,,~/,..~,[:,,/,,,,~/,,Y
<br />ToI~] m)~t>er: Living units........~ ........................................... Bedrooms ,,,.,-~, ..............................................
<br />
<br />Sep~i¢ I~nk: Distance tree well ,X~ .............. fl, Matericd ....... ,,~,~.,.~..,~,.,.~,,,,~,,.~ .......... ~,.~,, ,~.,....,.'[ ......................................
<br />
<br /> Total tiquid capacity ....,Z~.~..... gals,
<br />
<br />~ength o~ e,~ch l~,e ........ .~..'.?.. .................... .(..'q....? .........
<br />ro~l l~,h o~ ~ ~ ....,.~ ............. it.
<br />
<br />CLEAN NO. 2 ROCK:
<br />Depth under tile ................... ~ ........... inches. '
<br /> · _;7.-
<br /> Depth over hie ,,,..~.; ,t,z, ..................... inche~,
<br /> Depth of tile belo~ ori~in~i ground surf~., ./.,~,.,.,, .~,.,..,~,,..~.,.,, Inches.
<br /> Sketch of instcdlation (show loclltion of toad, house and septi~ system) '~".~
<br />
<br />Di~tcnce from:
<br />
<br /> ~o~ h~e:
<br /> Foundation .............. ~'-'~.~ ...............
<br />
<br /> Note: Indicate Northerly ~iirectiol~,~--.~..~k''~'~-~
<br /> Inspection will not be reticle until cor~'pleted f~'i'~eiumefl
<br />
<br />DA~ ...././.:...l.:.,.2.,~. ............
<br />
<br />(l:Oll IiEALTH D~PT. U~)
<br />
<br /> (2l Yellow -- Reference ......................
<br /> (31 PLak -- Installe~
<br />EH--43 11/71
<br />
<br />
<br />
|