HomeMy WebLinkAboutPermit 3350B11
II' "T
rnf
INDIVIDUAL SEWAGE TREATMENT SYSTEM INSPECTION FORM
SCOTT COUNTY, MINNESOTA
'WIt ~~Ifl<< q1J
Date of Inspection ~ <b~ttr' Permit Number 3?6t>- ~-I'/
(lfCfz~~
Inspection Number I, p-I
,./
Installer
ship SfJRIAJ6. LAI!.E
er ---4t-v1A/ S/17ITH
oject Address f"t-lf'b ZPIf
City ftIdtL'LAKe
OR..
Zip Code
L;'f)3~~
New
Repair
/go 2.<::
fiP
f~
-S--- f4'f
2-0/
01..L1 &,JD 0 C
DIST. or DROP BOX" TYPE
tRENCHES, BEDS,pR GRAVELLESS LEACHFIELD:
Trench depth 111
Trench length 4 ~ M I
I'
Trench bottom width 3
Trench bottom level V
Trench spacing "l...sj l' .If; ~ ::;... ,
Drainfield rock below pipe f 2" ,
Size ofgravelless pipe )) lit
Depth of backfill 1t. 1(.-iA' t'2"
Absorption area: square feet ~~V
lineal feet .2. ~ .
SETBACKS:
Buildings to tank(s)
Buildings to drainfield
Well(s) 50' or 100'
LakelCreek/Wetland
SEPTIC TANKS:
Liquid capaci~'
Manufacturer & type
Type of b,aff1e
Inspection pipes
Manholes access
No. & height of risers
11 (,'
4.41(.'
J~/V
Ai/A
Ii
q,RAWIN~ OF SYSTEM
PUMPS:
Tank capacity ~ 2. -::;tJ _
Tank manufactu rer & type B 1" .
No. & height of risers l~ y,,~
Pump manufacturer & model#~~lVAtp to 3d
Horsepower & GPM_, .~ -::s z """"'
Feet of head . l'~
Cycles per day "b 7YJ </
Gallons per <:yclp 160
Size of discharge line I 'I? II
Type of electrical hookup Ptl~T 6 T' Tttt) K.
Type & location ofalarm~
Cycle counter (commercial) .. ~
.WJ(
MOUNDS:
(':
Percent sl",pe
Upslope dike width
DoV(nslope dike width
Sideslope dike width
~; '.Drainfield rock below pipp
ie Depth of sand below rock
t: Perforation size & spacinp
,. Pipe size & spacin~
~;A\pimensions of rock be"
}1!. Dimensions of sand base
G'
''ilk Final cover
I.
IJ
J -7
'k
1
10'
I
70'
1-1)' 1?'
'It (
l
....
c; c: iJ c:
.".-';' 11;1 +' la'
,
,
Inspector's Comments /J{i/)~iiR- "5~ o.e.. -$d'b I.tj)htl> C"""'flG7"lrl~
e'6.tfJl~
q-~",
PutM(IE7J
,.. cb/~CDI FJ!c-p
I
C)(...tfO-~
..
Corrective Action Required
. ,1,.., . J1 ~ j ~\ . ~~
Inspector's Signatu4~ I ~P/'f/ Installer's Signatur. "t ~
~h ) White-ciounty. YellLw.APPllcant Pink-Installer
ar1670-2819( 12-94 5C I, '
4