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Sewage Disposal System Construction Permit PAGE _______ OF <br /> Commonwealth of Virginia Health Department <br /> Department of Health Identification Number /8Z S V '/Z u <br /> __ Health Department Map Reference ?7,e-/-19,4 <br /> General Information <br /> New ❑ Repair ❑ Expanded ❑ Conditional ❑ FHA ❑ VA ❑ Case No. <br /> Based on the application for a sewage disposal system construction permit filed in accordance with Section <br /> 3.13.01, a construction permit is hereby issued to: <br /> Owner Ee 1 Crouch _ Telephone q 3 0 <br /> Address C;(3 Pnf-nr (1t.er1 igg, 70 <br /> For a Type Sewage disposal system which is to be constructed on /at - 74 ,- ; , <br /> Subdivision Section/Block !.r - i - Lot / ? �`' <br /> Actual or estimated water use <br /> DESIGN NOTE: INSPECTION RESULTS <br /> Water supply, existing: (describe) Water supply location: Satisfactory yes ❑ no ❑ <br /> comments <br /> To be installed: class G. W. 2 Received: yes ❑ no ❑ not applicable ❑ <br /> cased grouted �< 'N. -- <br /> Building sewer: Building sewer: yes ❑ no ❑ comments <br /> I.D. PVC 40, or equivalent. Satisfactory <br /> Slope 1.25" per 10' (minimum). <br /> ❑ Other <br /> Septic tank: Capacity gals. (minimum). Pretreatment unit: yes ❑ no ❑ comments <br /> ❑ Other . Satisfactory <br /> Inlet- outlet structure: Inlet- outlet structure: yes ❑ no ❑ comments <br /> PVC 40, 4" tees or equivalent. Satisfactory <br /> ❑ Other <br /> Pump and pump station: Pump & pump station: yes ❑ no ❑ comments <br /> No ❑ Yes ❑ describe and show design. Satisfactory <br /> if yes: <br /> Gravity mains: 3" or larger I.D., minimum 6" fall per Conveyance method: yes ❑ no ❑ comments <br /> 100', 1500 Ib. crush strength or equivalent. Satisfactory <br /> ❑ Other <br /> Distribution box: Distribution box: yes ❑ no ❑ comments <br /> Precast concrete with ports. Satisfactory <br /> ❑ Other <br /> Header lines: Header lines: yes ❑ no ❑ comments <br /> Material: 4'' I.D. 1500 Ib. crush strength plastic or equiva- Satisfactory <br /> lent from distribution box to 2' into absorption trench. <br /> Slope 2" minimum. <br /> 7 Other <br /> Percolation lines: Percolation lines: yes ❑ no ❑ comments <br /> Gravity 4" plastic 1000 Ib. per foot bearing Toad or Satisfactory <br /> equivalent, slope 2" 4" (min. max.) per 100'. <br /> ❑ Other <br /> Absorption trenches: Absorption trenches: yes ❑ no ❑ comments <br /> Square ft. required — : depth from ground surface Satisfactory <br /> to bottom of trench ; aggregate size <br /> Trench bottom slope ;1 <br /> center to center spacing ; trench width Date Inspected and approved by: <br /> Depth of aggregate • <br /> Trench length ; Number of trenches Sanitarian <br /> C S 202A Revised 6/84 11 -2 <br />