381 NE 98 St (7)Installer
Inspected by
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Drainfield Trench
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Proper tank outlet device: Yes AO) No
Average depth to drainpipe invert from finished grade:
HRS —H Form 4016, Jan 86 (Replaces Feb 85 edition which may be used)
(Stock Number: 5744002-4016-4)
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Applicant 4-P & -' € -' - rmit Number c' 7- /a %
PART II - SYSTEM INSTALLATION INSPECTION AND FINAL APPROVAL
7 IA - Tank Manufacturer
Proper tank legend: Yes A0 No
Tanks watertight: Yes fi!r No Tank size ` gallons � gallons
Tank material ->'► e_7`4 -Ae- Tank level: Yes 40 No
Length Width Length Width Length a 1 feet x/ feet =c D ft
feet feet feet feet Length ' x — feet= r ft
feet feet / feet feet Proper No. drainlines: Yes L No(4 )
feet feet feet feet Proper pipe separation: Yes vNo
Total = ft Total = ft Distribution box level: Yes No 44
Systems located as permitted: Yes 17 No
Systems including plumbing stub -outs installed at proper elevation: Yes No _—
Manhole or marker to grade: Yes /- No
Absorption Bed
inches Maximum depth• . .,‘ Inches
Average depth of drainfield gravel inches Minimum depth of gravel inches
Proper gravel size: Yes ✓ No Gravel is suitable quality: Yes / No
Backfill or fill material as required: (Quality) Yes J No (Quantity) Yes
Other findings• -elti� _
No
( in, I tur es 7 A X <9 .t."1
�C ,a _ �- -
cce ca_a_7) Date g/O 7/1"
AN APPROVED I DOES NOT GUARANTEE PERFORMANCE
P - T II 7INAL INSTALLATION APPROVAL
I, l
Date ®1 Approved by 1
COUNTY UP BLIC HEALTH UNIT
gallons
Note: Completed copies of this form ill be provided to the applicant, installer and the building department.
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