Loading...
HomeMy WebLinkAboutPermit Septic Tank 1991-11-18 )> "0 "E. o' ll> ;? ",' Z ll> " 3 ~. lI> ~ l/O 0 )> 0 a. i a. m '" '" o ll> ro ~~ ~ ~ ~ * !~ ~ ~ ~ ~ ~ ~(Ocng.., ~ ~~~CD ~ '< ~('f\~ '\j'~ 'i~~~~~ t' !~:~~L~~~ J :... 'l\J: ~ i ~ "-I g~ . 'l ~ ~ li? ~ II ro -:::::: ,,~ ~ '\ ~ ~ VICINITY MAP - N MUST BE IN BLAC~ INK Permit NO.~.'2 '9 /t? - 9~wnshP. /'if Range L Sllction (J(o Standard System I)("Alternative Systllm 0 (Specijy Type) ./ R "-r"" '" / Job location (Stilet Address) /0 Vl/ '-Z:U? JJ H4 ~ 1'/-f:P!'. SupdivisionlPartition # . Parcel Lot. form c55-11 13 Tax Lot <J?/80 ~ 'Block DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED " USE BLACK INK ONLY FOR INSTALLER'):; USE: Trench Depth Gravel Depth Below Tile Tank Capacity /~ Manufacturer . Measured Distance from Well to Tank t! 17<1 From Drainfield_lu~--- Total length of Lines-1Y,~ COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION: I (installer's ame) certify that a (Mfg.) (Model No.) Pump and Mer Float Switch ~:lH1~o.)./ have been installed with this sewage installation. Signat ~~~ Date /(/r;/7/. FOR .sANITARIAN'S USE ONLY: COMMENTS' M System Approved o System Disapproved o Needs Correction System Capacity 'i4R') [J System Corrected gal./day Signaturp .......<l :..&--~ /' Date Date .I /-11-7/ INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When ~ned by the County Sanitarian. this certificate is evi- dence as per OAS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above location. To request inspection. return all three (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.