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CITY OF ELK RIVER <br /> <br /> P.O. Box 490 · Elk River, MN 55330 · (612) 441-4900 <br /> <br />~-.;ationofjob...////7z7/0 c.-~O0~/ /~/'//'C /'~/)/-'-) , <br /> <br /> . ' . % c~ ?. ,,'. .. : ' -~/. . ~ <br /> <br />Signature ~,~___ ]~ ~ Date ~~'--~ <br /> ~ (Show location of house, t~k, drainfield, prope~y line and well) <br /> <br />NOTE: On ALL replacements and additions, tanks must be exposed for baffle inspection: <br />COMMENTS: <br /> <br />New Work ~ Outside Lift <br />Replacement [3 Ejector ~ <br />Addition D Gravity <br /> Mound System <br /> <br />Tank Size / ;-~ <br />Square Footage of Drainfield Area <br />'~,pth of Rock Under Pipe <br />_ pth of Rock Over Pipe <br />Graveless <br />Depth of Dirt Cover t [, ~ <br />Number of Bedrooms <br /> <br />DATE <br /> <br />INSPECTOR <br /> <br />COMMENTS <br /> <br />THIS FORM MUST BE FILLED OUT BY A LIGENSED INSTALLER (ASBUILT) <br />(1) CITY COPY, (2) OWNER COPY, (3) LICENSED INSTALLER COPY <br /> <br /> <br />