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. <br /> <br /> Record Of In vidnal wage Dis l System <br />To Be Compl*ted by Installer <br /> <br />Sapti~ I~: DIslo~e fr~m well ~ ~ _ <br />Total liquid co,dry ~ ,._~.gol Inside length <br /> Dlameler.. /~ fl U~ld depth. ~ ~ ft. <br />Tile disp~al field: Distribution b~? Yes ~ No ~ Other . . <br /> <br />Tot01 length af ell llnes,..~ <br />Width of <br />Total ~uore f~toge <br />Distance baleen lines/~ ~ <br /> <br />Typ~ of filter materl~l~ <br />Depth ~f lillot moferlal over tile <br /> <br />~1. Well ~ ~ ,ff. <br />, ti. Nearest <br /> <br /> .Other ge~lh beneolh tile ,,/~ ,l~hes. <br /> <br />Note, Indicate Northerly direclio~. <br /> I~$De¢lt~n will not be mode unliJ compleled form Ir, returne~ tg the Health. <br /> <br />S~,stem apparently will J]~'~wwiif not <br />Remarks <br /> <br /> eFOR HEALTH OF_PT_ USI[I <br /> <br />funClian ~;~Bti~faetorily, end is Iherei'ore opprave~l ~'~"~Di~,oDpfoved [] <br /> <br /> <br />