Septic Info 8 Crownwood Lane eqof
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APP11CA*n0N FOR SEPTIC DISPOSAL,PER
DATE
K�AIA f-/my/ol
LOCATION OF PROPERTY FYR INSTALLATION
Owner�s Name:" `rq,q 'Telephone:
Address,
Installer's Name: Telephone. r. r.
Number of bedrooms (residential only,)
'Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one.(Viat , Rolling Steep Slope of slope
Soil. Nature: circle one�Lg'an'—�)" Loam Clay Other Depth; feet
Ground Water; At what depth? feet
Bedrock, or Impervious Material: At what depth? feet
Percolation test.- circle one. not req,uired required f rate min. inch.
Domestic water sLqq4y: circle one 6'--ici`-
.01 Well 0 ther
IF' domestic water supply is a Well,:
Separation: 'Wa,tersupply from Septic absorption feet
PROPOSED SYSTEM. Septic Tan X',----�
gal. ('minimum size: 1,000 gal.)
TILE FIELD: Each Trench feet / Total system length Zd feet
SEEPAGE PIT(S). Number of Size each feet by feet
Size of stone to be used # I I / Depth or Thickness feet
IMPORTANT
...Please...LIST NEW EQUIPMENT TO BE INSTALLED
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