PL12-1288 2&/]
TANK INSTALLATION
[01] TANK SIZE [1] 102KG {2]
C I
SETBACKS
[273 SURFACE WATER FT
[-I
[021
TANK MATERIAL C � o
C 1
[28]
DITCHES FT
[ •--Y
[03]
OUTLET DEVICE a
[ ]
[29]
PRIVATE WELLS FT
[,%r
I ✓T
[043
[05]
MULTI-CHAMBEREDY 99/ N ]
OUTLET FILTER jx
[ I
I
[303
[311
PUBLIC WELLS FT
IRRIGATION WELLSFT
POTABLE WATER LINES % Cp;@' FT
[t/]'
[06]
LEGEND,
[ ]
[ I
1323
[33]
BUILDINQ FOUNDATION FT
I vl"
[ 1
[07]
[083
WATERTIGHT'
LEVEL
[ I
[343
PROPERTY LINES FT
[,4
[091
DEPTH TO LID
[ 1
[35]
OTHER FT
I 3
DRAINFIELD INSTA LATIQN /
[101 AREA [1] Ls 2] CJ 7S5QFT
[ ]
FILLED / MOUND SYSTEM
I361 DRAINFIELIa COVER S/
[ ]
[11]
DISTRIBUTION BOR HEADER
[ ]
[373
SHOULDERS (/
[ ]
[121
NUMBER OF DRAINLINES
{ ]
[381
SLOPES
I I
[13]
DR,AINLINE SEPARATION.6
C I
[391
STABILIZATION
[ 3
[14]
DRAINLINE SLOPE
[ ]
1153
DEPTH OF COVER
ADDITIONAL INFORMATION
[ 3
[16]
ELEVATION {ABOVE EI;O gM
C �'1"
[403
UNOBSTRUCTED AREA
C I
1173
SYSTEM LOCATION
[
[413
STORMWATER RUNOFF
I I
[181
DOSING PUMPS
[ �l
[423
ALARMS
[ ]
[19]
AGGREGATE SIZE ij/�' �-
[ 7
[431
MAINTENANCE AGREEMENT
[ 3
[20]
AGGREGATE EXCESSIVE FINES
[./I
[443
[453
BUILDING'AREA
LOCATION CONFORMS WITH SITE PLAN
[ I
[21]
AGGREGATE DEPTH IV I l
[ V]•
[461
FINAL SITE GRADING
FILL
FILL
/ EXCAVATION MATERIAL
I A-
1473
CONTRACTOR
[ 3
{22]
FILL AMOUNT 471.1-
[ I
[483
OTHER
[ 3
[23]
FILL TEXTURE
[ ]
[24]
EXCAVATION DEPTH
ABANDONMENT
TANK PUMPED
[ 3
[251
AREA REPLACED
[
1493
'z�
I I
[26]
REPLACEMENT MATERIA;,
{�
[50]
TANK CRUSHED & FILLED
EXPLANATION OF VIOLATIONS / REMARKS
zz
14
[ I
[ I
CONSTRUCTIO • APPROVE ISAPPROVEDI: -- _ CHD DATE: Z,
FINAL SYSTEV,��DISAPPROVEDI : u' ® CHD DATE:
DH 4016, 08/99 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3