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1 <br /> /iG WV iwu.v•----••• <br /> Coun • <br /> nl 5-reset- PE-: - • <br /> - •, 1 ' z' — <br /> Plum•er s Name' M' ' N----• - - S nitary Permit No.: <br /> �0 •._ 41/7 9�r <br /> Permit Holder's Name: A ❑ ity ❑Village •: own of:e State Pfan ID No.: <br /> "�C(.•464 6eglh , C?LCLI- vt.l+- A F, sr,-.34( S, r � Parce1J xN <br /> CST BM Elev.: I/Insp.BM/ley.: BM bescription: /�� , el / ? / <br /> / Y 7'cfb lG�% I (G�i �� !"�_ �t3��` �� �15 �� ``^�r 7 —z �+i. <br /> TANK INFORMATION c(,(.,� s� ELEVATION DATA <br /> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. <br /> Septic 5 c (3�oc 6(mee Benchmark /? / /I / / <br /> C X25 /05. '-' <br /> Dosing � ( o0 0 �- �.�. (p� C+ <br /> -Acratier�. 6a.eP�. :..S�FCC�t `� 11 pence-� Bldg.Sewer ?,A/7 / e S55,( . <br /> Holding !�` <br /> C StNHt Inlet 7 3Rl c�o , '6a <br /> TANK SETBACK INFORMATION -It Outlet ''• („„Or 26,60 r <br /> n _ / <br /> TANK TO P/L WELL BLDG. vent to ROAD . 4 t5' ,Q 6,!of 7 - 'S <br /> Airintake <br /> Septic - r A.j'" )S / d f-" NA , - t-iilettem- ova ��_�'6(*gt �4 <br /> Dosing 5./ r ��5. -f >I0 r NA Header/Man. tea , // ..Zc <br /> .��2..>A( Jc > S c N " NA Dist.Pipe BfLJJz: 4 .S fib f<l• r <br /> Ho . Bot.System's .5.$4 f `jt,56 <br /> /PUMP/ IPHON INFORMATION Final Grade - l)t . C-`Zh 1 X10. 26? <br /> Demand Po,�-P7�a I( -2",J /3,U S3 , <br /> Manufacturer (�Cl„� <br /> Model Number S ( - S'OGPM / P 7' ro" , /a / <br /> TDH I Lifgo,I I Lo slog 1 Ff roaAH TD <br /> Forcemain ILengtI (t f I Dia ry Dist.To Well - • <br /> SOIL ABSORPTION SYSTEM L.� } <br /> BED/TRENCH Width Len th ( No.Of PIT ' No. Inside Dia. Liquid Depth <br /> DIMENSIONS �r III(o. I DIMENSIONS nufarturer: <br /> SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING <br /> SETBACK t CHAMBER Model Num <br /> INFORMATION Type Of �5 ro( 0 OR UNIT <br /> System-il� <br /> DISTRIBUTION SYSTEM <br /> I Distribution Pi es) ' H. -Size x H eS acing VentTo. JrIntake I <br /> Headers anifo� �j rr -'n �. 1 <br /> �-1Dla5 Length ! 1 . a Dia.4 SpacingA t " I ^..,-* , I>(0 <br />• Lengtf� � I Y <br /> SOIL COVER x Pressure Systems Only xx Mound Or At-Gra•e Systems Only( <br /> De th Over I xx Depth Of xx Seeded/Sodded ` xx Mulched <br /> Depth Over p 11 I Yes [] No • <br /> Bed 1 Trench Center 4 ( Bed/Trench Edges Topsoil NO <br /> CQM (Include code discre ancies,persons present etc.) <br /> o' Cp►-.I `, -r--.1 � <br /> � I--'t-cg,5 C. sC. T.�i3 r I--t 0-03 .._,, -4— <br /> e.5-K 'ren 2:-.)/NeL1F--i-C_ / <br /> ,sitao, etbs,„ litPes- ,2-,)-7 41-f7, hil. /16 411r. <br /> Plan revision required. ❑ Yes MNo / '( / '' <br /> Use other side for additional information. (C 0.s -11: // 6 <br /> SBD-6710(R 05191) <br /> Date s.- or's ignature Cert No. <br />