HomeMy WebLinkAboutPermit Plumbing 1996-5-10
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- (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. .
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SECTION 3:
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Permit #
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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.
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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 .....~~<_-'