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■ <br /> pc,Iry tT4J■•\.•••••••. .- <br /> Co ty: <br /> PI m 's Name: R Wjlo.: Mary ct, <br /> hEe.3 Z o/6os - fit <br /> Permit Hold is Name: I l City ❑Village Town of: !� Stan ID No.: <br /> W /J� QrJ !� � a C Parcel Tax No.: <br /> CST 8111 Elev.: Insp.BM�lev.: BM in: I <br /> I �l I Y,7a��/ '" -$,V3, t° � . CYa-ae-3 /`r5&' <br /> TANK INFORMATION ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. <br /> Septic C..kEilie in-4- Benchmark '43/ ft>ei <br /> Dosing riC I (OS c) ) qv 1 17-/ / f <br /> Aeration Bldg.Sewer <br /> �i / <br /> Holding 4 S t Inlet dh%I►� ' 41 , ' <br /> TANK SETBACK INFORMATION 4 t Outlet /j` �S' 94415/ <br /> TANK TO P/L WELL BLDG. per ntake ROAD Dt Inlet to as;ir, j 7171 d , I/ / <br /> Septic 'ar >4045 1 /JA,- NA Dt Bottom ! �,,i�a�/ O r /x401 <br /> Dosing >a2 ( 7261/?-5.( >/a/ NA Header - 14 . -1.'w— . <br /> Aeration NA Dist Pipe '.4 /0, e <br /> n Bot.Syste 1 _, 4 •'0 <br /> UMPI IPHON INFORMATION Final Grade <br /> _ - Grad e <br /> anufadurer 40-01-10'S Dem, , , i. � . `rva` I O r3/ <br /> . }' ,Model Number f ,p old i,... <br /> TDH I Liftg 4bri Los 1 r If I Hete TD C ?F <br /> Forcemain fL.ngthp$1 I Dia&te I Dist.To Well . - <br /> SOIL ABSORPTION SYSTEM <br /> BED/TRENCH Width q/ I Length/ I No.Of PIT No.Of Pits Inside Dia. I Liquid Depth <br /> DIMENSIONS '/p _ I DIMENSIONS Manufactu <br /> SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING <br /> SETBACK CHAMBER Model Number: <br /> INFORMATIO yyse�4yw / ;�;6( i►.J 71 ____ UNIT <br /> system: . la <br /> DISTR : SYSTEM verrtToAirntake <br /> Heade t n,�*� N Distribution Pipes) ' v %r x H Size x Hole Spacing I nt�_ I <br /> Qn '�b ` 1' � 1 <br /> I Length b r�'•ia. A Length 24 Dia._J--? Spacing-�: G <br /> SOIL COVE• x Pressure Systems Only xx Mound Or At-Grade S �� <br /> D ,th Over Depth Over xx Depth Of/ K I Seedodded xx Mined <br /> Il I l No ❑Yes ❑No <br /> /'. . l rench Cen •r a, Trench Edges (� Topsoil ❑ <br /> IrrOMMEN •: (IndYde,c (divr ncies,persons present,etc.) 4' IALA4Entk- <br /> ' es� ( (fir-r-sr`Glt,g ell. s^l.- <br /> t <br /> IIIIIIPAM <br /> Plan revision required? ❑ Yes No MI C- •.��� ��cr <br /> Use other side for additional infor 'on. - TA �� /?U�� . fie+ <br /> SBD-6710(R 05191) Date v I "toes Signature Cert.No <br />