Loading...
HomeMy WebLinkAboutPermit Septic Tank 1981-5-13 ... ... VICINITY MAP ~ 24kJ CN.MO.5> rc..Oc- . I nstallp " - .Phone License No. Bonding Company - .R'J .f\~V1- 1%l. !TItle as shown on OEQ license} If Installed By Owner- ~/ ~r. LCr,,lV1ad:1AftIUt DateY - 2 4- 'it I ~ie~~~ -::Spf'iWyfrJrl .:cY2- . Q74'1'7 ISlQnatureof lJcenseeJ Datp MUST BE IN BLA8K INK form c55-11 Permit No. --.Cn~')-li Twnshp. 1'7 Range <z, Section ?,,2,'!f:1 Tax Lot I tLl StandardSystem]i!(AlternativeSys mD (Specify Typel q?O(YlJ..? - .00. ~+, Job Location (Street Addressl 5ll {}(J 0 Subdivision/ Partition # . tffi1l.A_ Parcpl Lo'"-0 Block....dY DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED 12~eJL -fu catetchfd ..sc~ dJ1OW0 Scale - " ~ &f- ~ ~. . J'\ \-"!}1 /~.~ \.,- ~~ to' . ~-./ ~/ ~ <'0. ~? :..r~ ~ ~ C- o T~ ~C": r.J> (A - - ~ <:- 4.. '7 - <a ~-"", ' G 1< '?o .... ' 'PA ~ "' ,n ,/ ';- 'P ,v, /' ..... \ \ /. ,'" . USE BLACK INK ONLY FOR INSTALLE~~~~: Trench Depth. .~3()" Tank Capacity n~ '\ Manufacturer Measured Distance Irom Well to Tank From Drainfielri COMPLETE THE FOllOWING IF A PUMP WAS USED ON THIS INSTALLATION: I linstalle"s name) _ certify that a IMfr', - and Mercury Float Switch IMfg. and No.1 (g_g I, G ravel Depth Below Tilo Total Length of Lines.Qk;l-ISD Y\Q.W - 1c.J3' IModel No.1 - Pump have been installed with this sewage installation. SignaturlO' ---- Dato ;g"System Approved o System Disap FOR SANITARIAN' COMMENTS: o Needs Correction System Capacity. yf:[) I] S ysteJl], Cprr!jc)ed qal./day Signature. ;fcCUM f/IJ, iA.flOrv/lAJ/1.{Jj{I Datp Date 13m~n INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian. this certificl.J is evidence as per QAS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above location. Keturn tnlS torm to: tlUllOlng ano ~anltatlon UIV.. Uept. ot enVIrOnmental Management, locateo In tne casement ot tne Public Service Building. 125 E. 8th Avenue. Eugene 97401. . .~ a~-g-I )'1-03- 20, '-J, L(:Ji;.) I Lf 3rd I1dd J1JoIU1,wood ~ Joj-- J q t3Iod< 6 Lj ZtlBD WYW:lS /Vb W,' c;o,;{ I VI. /ocu.I~ :2 "X. .Ja"..Jc.- U) i!J-/ g Empflor1i.dJ N-i!J,. L. ' J r-l('2- 1:;j~ ['1-0 (Tn h,1 . S~SICL- fl, 42 oj- 9.r<ltJ #T~lu. 6] /0 ~ ~sJdL. ~.!.. ?11 bo~ 5'" . ., r ~ I " . -' 1'01." pl"gdes,~ .,lell/N... I , S"~I~ .. ,,~~ o~ s..s~", ,..."tI. b""~ ..... _ _..... :="'_ buT Wh\~C4AIoIL.-~\,jo 1.~ - - - - . ~. ...t.... _ ,.- , ~ ! /~~U0 p~/ '0~ , WW\ctS DriVe..; "2lJ' '. / ~,/J / /"S,oD ___~__._.~J 1./1.' ~ ~',:' / (ft/I~ ~ . I ~ ~I ., Hf)~ ~l) l..i.uC$ ~fo.JC1.1 old. ~foc.. ~,rv-l So Ii b "1 v...k N..,.; A.l4 IN. '" 10 s~$/<." .." 193 L,.. Fi , ~"o . '9:) '-- '~~<:.D ;; ~ .\~~ ..'~:: -:3 ~ a. \~~\ .\ ,\ SJ l\.,\\)'O ~~ ~ ,- \. ~Y' ~\~I; I' 1lI\<;\1:l .. ~ --: .. . -~~,,\\~~~\\~ !.. ? . J; ~-..ft'''- -<'- , h0'Tr'N-r{:. f5 c3 S? ~ r-----. , , I ~'O-?> 1/"_ 1/ '16 -