534 NE 94 St (7)Installer , A i ,i ,» f E S/4 / EA,/,s` .�ri/il C Tank Manufacturer
Proper tank legend: Yes No Tank material Tank level: Yes No
Tanks watertight: Yes No Tank size• gallons gallons gallons
Proper tank outlet device: Yes No Manhole or marker to grade: Yes No
Drainfield Trench Absorption Bed
Length Width Length Width Length d-® feet x_/ feet =,--9- ft
feet feet feet feet Length ^ feetx feet= ft
feet feet feet feet Proper No. drainlines: Yes ✓ No
feet feet feet feet Proper pipe separation: Yes ../ _ No
Total = ft Total = ft Distribution box level: Yes No
Systems located as permitted: Yes No
Systems including plumbing stub -outs installed at proper elevation: Yes No
Average depth to drainpipe invert from finished grade inches Maximum depth' Inches
Average depth of drainfield gr I: _ 3 inches Minimum depth of gravel: /inches
Proper gravel size: Yes /No Gravel is suitable quality: Yes 1 No
P 9 q Y
Backfill or fill material as required: (Quality) Yes f No (Quantity) Yes , t/ No
Other findings:
Inspected by: / frcJ/
Date
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Applicant Hier ,Z, /i - /` La /t) Permit N ber �� I air‘
PART II - ST EM INSTALLATION INSPECTION AND FINAL INSTALLATION P PR OV AL
Approved by
S o TyCfP/y /; ; Date q /
':ompleted copies of this form wi be provided to the applicant, installer and the building department.
4016, Feb 85 (Obsoletes previous editions which may not be used)
,tuber. 5744 - 002 - 4016-0)
PART I - FINS(' INSTALLATION APPROVAL
I 019 - 4e
r 4 COUNTY PUBLIC HEALTH UNIT ti ,
AN APPROVED INS I LATIO' • • S NOT GUARANTEE PERFORMANCE
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