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HomeMy WebLinkAboutPermit Septic Tank 1994-9-12 )'15FN-;,c'pJ:nl_7J!I q7~7<;( -. Please complete all lines InsIde whIte boxes, If possible ne it'" r. I-IC>rl/e y./!e/eJrt/fprpeY ct- 7-9J/ YO1M' Name~ / Date t/ qO c; 0./ <?rl-. =c; ~ Your Mar'; - . . "iP;-.' n <(;c, 'I'" 1,[ etty- ./ , 71/(-(00J I-'none '17'/71 L4> UWl\8I 01 t'ropeny (n ~ same as aDOV8) ""'"" OWner ADa.... II noI HlT'8 UllDOYel L4> lnstaIlarl BulllS8rl contracIor CCBLlC8r8.. """'" ..... . .................. ......... ... ... ... . ..................... MAP, PARCEL NUMBER (Found on tax ~ In 1M Aueunwnt. TlIUtIon DepI) t7 ~ J.f, ,"? -i.2.n/ Towriahlp lJ4Sectlon T...... TOwnlhlp lliiijjO ....... 114 8eCUon TaJ:Lot IOwnalllp 1linjjO sear..- 114 section laLGI Site Address t/Cl/) 'f~ 79-/,,1, - Ma}')er7;;t To: 11 !. -f1 .,.hj Ie PM ........... ?fa 0 C'n 79""-L. ........ . -.J ' .7or.'175-f;f>/J Orp""'" euy , -,..., lit=' Y //.0 y ,)'-/: -. ZIp <;?..7 4 '"7 </ ExIstIng Buildings 01' 1m- prowmenfs on the Properly ~use _Barn ---,<",Garage _ Mobile Home -'C'Shed SEPTIC INSTALLED? ...J,CYes No Water District .IV /J Directions to site from nearest main Intersection Jt1 ,;t 1=1-0 h1 9;. ~i=~/,( Oh nf. "'" z.'" f-/ Lv V "ta. 5o,7,WJ, 11 J G'n ap 5:, . "7'11'1, /A-'o r;'// YO" Jc>e Jj?1} at. r:~ f., -1-. U??kX kin;, For Mobile Home Placement Only Brand Year Size No. of Badrms Ucense# (No. always starts with Xl X- Distance from Mobile Home to: LMD staff can NOT be held responsible for evaluations or recommendations based on false, Inaccurate or Incom- plete Information. LCPW 14g - MI3 . W: 3 LANE COUNTY DEPT ENV MGT RECEIPT 0 260394 DATE 081094 APPLICANT HERVEY, DALE ADDR 490 S. 79TH ST.. SPRINGFIELD . TUI' 1702363004201 SUBDIV LOT BLK . NEW BLDG TYPE USE R BDRMS 0 UNITS 001 STORIES OBLDGS 001 PHONE 746 6005 OWNER NME HERVEY. DALE ADDR 490 S. 79TH ST.. SPRINGFIELD . CODE APPI.., NO (,CnON DESCFdPTHlN SQ FT UNIT COST Vr~L.lJ{~TION FEE I, BP. IU I ElF' . [<I" IW BP . . , . \' ~ ~ I ,.[,,! . 8 . . dH . . . . , r t ~ . - . . PI... OFIl/BATH: MECH . SUF< PCI( SDS LC 260394 SDSR . SDEQ FE:t: SDSI~ ) ~ I ~ CATC;: PI...N SEQU: . TAI(t:N BY riL.C S'DS 1';:1', EST ., . '" ,'i:!/>jr-~~: FT ~ WTF~: MECI-I!',NICAl.. FEI~ ST f', Tf:: SI.JF:CH,;,I';:GE PLt,N CHECI.< FEE ;::,1...1::, I"'CI< IS'S ~? CUriF'LET ION D,~TE . . 8 " . , 8 ~ . 8 .{ ,,\. . . . .' . . Dr.,: \j:r .: . FT. f<AIN: FT 81 ~:; ;;: .~ 2~5;~ 100,,00 10J)O , .( / . SI on, ~ I i. . ... ~ e[ (''t: i~ DEI"'OSIT ')("f 11 ()"O() Cli.! " I f .J ! .l ,;.-- )> ::;: OJ r mI :; "0 :; ~o o. CD en "9- -...5- '" ~ 0' en ::J "0 ~ ~,g' en ::J" ~ OJ '" 0 :a CD ~j Z ::J en- 0. D ~ , Z Q" '< OJ ~ ~ 3 j 0 OJ ~ '" , :;; ::J "" r i ::J '< "" , '" '-l \II )> ! T f) ~ I 0. i ~ 0. a; \i:l ~ it .~ en ...., . en (\ , ~ l ) . , I 0 0 i1\'. OJ OJ CD CD ,,~ ,~ ~ ~ VICINITY MAP ~ v, N " .... , ..... 5/f:P nttll-l 5 T. (/1'f'il".1/C) ;'+'\1.11 " ...(l -:.', , '.- -:2. Qfl MUST BE IN BLACK INK Permit No, Z{oO ~ - I 7 . Twnshp, 17 Range _/"J7. Standard System~ Alternalive Sy~tem OrlSpe.9Jy TYLle) Job Location (Street Address) L/fi'n ~ I -/qTV" 5f"/UtVa:.f:-U:?Z.D Supdivision/Partition # . ' . r Parcel_ Lot 3 3 ~)ormc55.11 Section G:,_ . Tax Lot ':tZfJ/ <5r / 'f) tI"f Block DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED 10.,,..1611 , \,. 5orL, / }Io~ :,,, ~ O~~W\1 Scale = ~ N . <J>':- ......'6";t;,-:t. ~~%~ ~-('{' .-o~---c -gc;.-:t,('(". ~t3~"?}j o~~~ ~:::; ~ ...._y'-- O--f\~'.L ~c:o_ o~ e>%, 17 ~..v 'P '6~r~) u:>~~~...... ~:..o.L.~ o~......~ '2.~-;:t:-,.: (j}Cl~(f' o(\"'.~~ -;Z-~ <J> ....J::::;..cP~ ~:-:t. ~ .".. ;. " 'j J 1- ~ .1 ..,.,..,. ~ ' I3fVf)~ "Y 795T, :;~f - 9 199~ USE BLACK INK ONLY t:;NVIRONMENTALJ1EALTH FOR INSTALLER'S USE: Trench Depth :J.'In Gravel Depth Below Tile t. Tank Capacity _IOOOc>~ Manufacturer WILL r~Il/l.Y ''TV'''''' Measured Distance fronl Well to Tank N4 From Drainfleld Total Length of Lines~ COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION: I (installer's name) certify that a (Mfg,) (Model No,) . Pump and Mercury Float Switch (Mfg, and No,) have been installed with this sewage installation, Signaturp Datp FOR SANITARIAN'S USj; ONJ,Y: ];l('System ~pgrove~ ~' S stem Disap, proved 0 N~~9S corre, ction' COMMENTS: -rtJt 7 c!.dr1:.TlfCa;4Tk 15. fJ~~/ ~ 14J504i:j'.J'.JY'l5 /PJ5r~YI'/7?flV :-TA--r~rr ~jOrec::;> 'l-feYre-0vJ.' 0 teri",ccyrected Date (1- if System Capacity LlSo gal./day Signature ;; ~ Date CJj/Z/Y 7 INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian. this certificate IS evi- dence as per ORS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above location. To request inspection, return alllhree (3) copies 01 this form to: lane County Environmental Health Services. located in the basement of the Public Service Building, 125 E. 8th Avenue, Eugene. OR 97401. ~ ...-::. & e- Subd/vioN FOR J: H. PAAII-, O..//>/ER Rf. .2 ) 80;( .378 A ,796'6.f3S- Sp,q;"v<j'{;Eld) OAE'10N .soul),w~...1- Co,qAlE:,q 0/ /),c' Nel.5oN .DAvIS lJo.,..!AlioN LANd ClAiM .No. 50, TOWNSh0 17 :.:5oulh, RAN9E' 2 w,,",t, 01' iJu: }A/,i'I.....M,c!,IC MERidAN. M-<' Lal No, 4.300, :c: 'i."-. .'i', (,. . /....;.:.["1[,-.,..'i. . :;)':':" --- _____------- t ----- '", ------- - ()- 1..:, ; ".: ' . '~, 1 ". ;' ;'. l: : l i 1 : I'- '- . . - . I. " --1~ " /,'/ ~? , "'l~.-:"C: V~tJ.u''''''7LdL- - 60 - _...,.,lid;X-(.4:.o.-;7_...:':>..:...;...6;?"?-1~ .'d,[",\ (d~C;--;7 ) . 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