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HomeMy WebLinkAboutPermit Plumbing 1996-5-10 .' " tRE. UJveR :I:'J-l.<:110 : 'Rto,U IR.~D._-:l ~:~~ '~~~.-r'~ - (j , SEWAGE DISPOSAL SYSTEM "AS BUILT" PLAN (Date received) ~ant to tho rcquremcnts within OAR "54.665, OAR 340-71-170 and OM 340.71-175, U1e sptem inslallCf aOdfor tho pocmitlee mUS1 ootify the departmenl of -. II Quality (or i1s authorized AQeol) when tho oonstf\ICtion, attenJlion Of repair of a system for wl1ich a pemlit was issued is (lOlnpIeted (exeepI for the badd"dling Of coYOring of tho ~). The Oepattment (or AQoot) has scvcn (7) days 1.0 porfonn an impodion of the o;:xnpotod <:onStruction.nor- the oIflCial noI.ico dalo, unless the L... -. - (or Agont) elects to..aive tho insped.ionandDUthorizostl'lelystemlobobad<f.nedear1ier. Roc:e.,.e...:l."__..-,_.. ..ofthis __ .- _ ..kwmbylt1eC._ ','. "(OfAgenl.)ostabIishesCheoKlClalnotioadatocAyour requcstforthepre-coverinspecl.ion. Pleaseoom efln sedionsollMfonnandrelumtolsne nYironmenlalHcanh 15 6lhAve I 7401. SECTION 1: BASIC INFORMA liON Permit # 1/f17-fC- I // MapfTax Lot #-L7. ()<, !JL . /. ~0cro To Be Comoleted Bv Installer: PERMIT ISSUED TO: Name:.~tV~_z./'iJt/;h, '~ilimAddhess~' I ' ~,rO. - ~~/m<~ <J7~of Property Address: la'f _"d I-f" .Lo-.t5ru~.P ~~.~ , TOTAL #: Bedrooms_ Living Units _ Basement: Yes_ NdJ....!:!.-' " WATER SUPPLY:, PUBLIC )!I. Individual 0 Community 0 Other (Name) , ~ECTION 2: Materials List (Identify and list all materials used in system): SEPTIC TANK: ~Concrete 10 Poly 0 Metal ' Manufacturer w 11/ ,,-_..;r! ~ G-v-A-6/ 6~"-'e. Total Liquid Capacity ISo 0 qat. Distance from Dwelling 1':\ ft.; Effluerit Sewer ASTM # ~ Distance from well S- ~ ft. DRAINFlELD: Total Linear Feet3Sn Drainfield Pip,e (ASTM#) 'l> ,i:11]~q; Header Pipe (ASTM#) b;J? 29 Depth Rock Beneath Drain Line Co in.; . Depth Rock Over Drain Line...b.-in. Distance of WELL from Closest portion of DRAINFIELD 50' , Mfg.fType/Size of Rock Filter Material ~. Q. R ,(!J u. "'~~'1 I !/'? IS> Feorl. \ PUMP SYSTEM: I (installer's name), certify that a (Mfg.) ,Model No. ,Pump and Mercury Float Switch (Mfg. and No.) ,!lave been installed with this sewage installation. (Complete as Applicable): Wor1<ing Capacity of Chamber qat. Gallons per Cycle qat. 'Wor1<ing Capacity" remaining after alann has activated qal. ' Signature K.I..l '-r-1, B..u-L+, I DateS - ~ - G (..., OTHER: (Materials not listed above) FOR SANITARIAN'S USE ONLY: ~stem Approved, D System Disapproved 0. Needs Correction CQMMENTS:_~ egJ"ffJ.~L~'~r;, n1l5:.. . ~~()- ill- 17D(;;"1 -" p ~ , -rlJ:;,. I ,,-:'/I-tt::!111) ~ _ ,';'" L--- ,.-.J'.AA... ''J. Sr -r:;; .~ '._,_.~.^.~.'''':'..fl ) -c., "'>r!- , 0. System Corrected; Date: System Capacity C'aVday 'Signature ,~_? ~O~ J2~ ,," Date S - ID - 9t" ' I.NSTAUA TlON RE(JO & CERTlACATE OF SATl.SfACTORY COMPlE11ON. When signed by the County Sanitarian. this certifICate is evidenCe as per ORS 41$4.665 of satisfactory _"'r:_~~'" of a $ubsurfaCC sewage QlSposal system at the above location. . (over) . SECTION 3: . ..'~(. . .\,~~...~ . "':-:'i:~L~~'" 1-. L,~~\\ ,. 9' 0'<1~7:' ~.:' _ -f;, .1r' I, ii , (over) . 118') Permit # ;~. AS-Bll/L T PLAN OF THE CONSTRUCTED SYSTEM. Show the following: North arrow, septic system referenced to a fixed point. such as, building foundation or property corner., property lines. wells and water line's within 200 ft., drive or walk-ways. all buildings, property dimensions."streams. ponds, cuts. escarpments (>50% slopes), Include final grade shots of ends of trenches. distribution box. and septic lank outlet elevation. .......***......*******...******************....**.***..***......*********.*******...************.*************.**** , ' ~'.-,,~~;:7 .'\.' /' ./ if.:r <!. e.u -t:~ y /.. 4- 1- T~-e. S l( ~ '-/-e..--. $ ~ b,-,,,~ A, -e..- .e. <!..o otJ +<> "',.,. s 't' 0 , <34 '" 3 HD -(\,., U l Sto'<-<, 7 If'r I\~ B~ ~ - 8:.- '[,6 ...,. -- /, -'3'" 10 " 'tt ' ~o .. J VICINI'rY, MAP .~ N +:I",'i d6A./ &.~r. T: ~~ "'~\ t~ ~ :l r> .'-:,' f\d _II> t'l' '\ l> f/~ cle,u lSV"ldtp ~ /fe!..' 1 { b' Ct ~ ", .>--- " P;"/d'€.. .) 'LV;/' , 17-.. <f. 7 It-lt:t .!I~ , ~p0(01"L: ~ , . , L\ L0e. o <iI' J:" ,I X '''f''i;",le-e \ So.. 'l.,.., D ~OiL 'I"" q6 ,j..., ~o q ()'. 'qo -10. 'fo 'J' -:..... ': .,~................ J,o' . __~_., ~ Yo , ' _.*._-***-* I.certify the inforination provided in this notice is correct, and that the construction of this system was in accordance with the permit and'the rules regulating the cOnstruction of , , an on-site sewage disposal system. I have tested the septic tank for water tightness per OAR 340-73-025(3) and found it to comply. ' Installer(PI;"'sePrint)}?~"""" ~1I.4 <?o-uS7" {!{).:T,ve (TrtIe as shown on OEO license) . Telephone . ? 4 {,- ??035,- Ucense No. ,-<! <I h<( is ' Bond,ingCompanv '. ' #4~-r -+''''--0 ' Signature GI1:f:. '0 .....~~<_-'