HomeMy WebLinkAboutPermit Septic Tank 1983-8-1
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~_" """ . REPORT OF INSPECTION - INDIVIDUAL SEWAGE-DISPOSAL SYSTEM
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PRIMARY TREATMENT consiSls of IBSeptic tank o Cesspool
Septic Tank: . ~ '., ,-,p..
Distance from well, a feel. Material, ~ Si J
Total liquid capacity, v q 0"0 qallons. Capacity inlet compartment,
Inside length feet, Inside width, feet, Liquid depth,
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Number of comparlments
.I
gallon.,
feel.
Cesspool:
Distance from well, feet; foundation, feet; nearest lot line at 0 front 0 side 0 rear
Inside diameter, feet. Depth" feel. Liquid capacity, gallons. Lining material'
SECONDARY TREATMENT consists of oo1'rie disposal field o Seepage pits o Other (Sl'ecif.vJ
feet,
Tile Disposal Field: /
DiSlance from well, feet; foundation, /'1 feet; nearest lot line at 0 front 0 side
Total length of tile li?es, feet. Number of lines, 1-. , Distance between lines,
Trench width, .:J. (. e , Tot'li effective alxorption area in bottom of trenches, .,t:ro
Length of each line, I C70feet. Depth, top of tile to finish grade, .3 0
Type of filter malerial: ravel 0 Broken stone OOther (Sl'ccif.J'J
[)"pth of filter material beneath tile, &, inches. Depth of filter material over tile,
Seepage Pits:
Number of pits, ' Outside diameter, feet, Depth, feet. Lining material
Distance from well, _ feet; building foundation feet; nearest lot line at 0 front 0 side 0 rear
Inspection made by: o State [J.eQ'unty 0 Local Health Authority
~ (f) 111fJt feet,
J b I feet,
square feet,
inches.
,
~
inches.
feet.
Inspected by
Ac) A--- R..r
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-(1--..?'....~.~.,;.;- /
(Tillc)
Date of inspection
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Distance to nearest public water main, feet. Size of main,
Individual wells Dare Dare not customary in neighborhood.
Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water
REPORT OF INSPECTION - INDIVIDUAL WA TER-SUPPL Y SYSTEM
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Properties in neighborhood 0 are 0 are not being developed with both individual water.supplV and sewage.disposal systems,
Lot size: feet wide, feet deep. Dwelling set back from front property line, feet.
Individual water supply from: 0 Drilled well 0 Driven well 0 Dug well 0 Bored well.
Distance of well from:
Building foundation, feet; nearest lot line at 0 front 0 side 0 rear feet;
enst iron sewer, feet; tile sewer. feet; septic tank, feet; disposal field feet;
seepage pit, feet; cesspool, feet; other sources of possible pollution, feet.
Well cOf.lstructron:
Diameter, inches, Total depth, feet, Tvpe of casing, , Depth of casing, feet.
Approximate depth to pumping level of water in well, feet. Approximate yield, gallons per minute.
Sealed watertight to depth of feet,
Exterior space around casing sealed with: 0 Cement grout 0 Puddled clay o Ordinary backfill.
Well cover: o Concrete o Wood 0 Metal. Openings in well cover watertight: 0 Yes 0 No,
Pump: o Shallow well 0 Deep well. Length of drop pipe, feet, Pump capacity,_gallons per minute,
Located in: 0 Basement 0 Pumproom off basement 0 Pumphouse above ground 0 Pump pit.
Pumproom properly drained: 0 Yes 0 No. Pump mounting watertight: 0 Yes 0 No.
Type of storage: OPrcssure o Gravity. Capacity, gallons.
Has bacteriological examination of water been made? 0 Yes 0 No. If answer is "Yes," give date , 19
Quality of water 0 is 0 is not satisfactory for human consumption.
Installation Odoes o does not comply with approved exhibits, if any.
Inspection made by: 0 State OCounty 0 Local Heallh Authority.
Inspected by
Date of inspection
,19_
(7I//e)
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