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HomeMy WebLinkAboutPermit Building 1980-3-14 . POST THIS PERMIT ON MAIN BUILDING AT SITE /~ 1>5'~ JOB' ADDRESS ..H::'ro Menlo Loop Eugene, Oregon CONSTRUCTION PERMIT # TRS, TL 17-03-27.3.3 # 2600 SubdivIsion Menlo Park, Lot 9, Block 3 '~ LC-537-80 This permit for the referenced property IS hereby approved. Setbacks and other conditions of approval must be strictly observed Violation can result rn revocation of this permit, citation under provIsions of Lane County's Infraction Ordrnance, and/or other remedies allowed by law Applicant/Address Roger A. Harrison, same as above*** Owner/Address same Contractor/ Address! Contractor's OS # / Total Construction Value Telephone Telephone Telephone ConstructIon approved by thiS permit $16,038.00 v1fater Supply Public PLANNING DIVISION WATER POLLUTION CONTROL DIVISION 747-3380/484-1125 same / Addition to existing bedroom/adding farn1ly room and bath @ 455 sq ft; Install wood stove. Structures now on property: existing house. # Bedrooms na # Plumbrng Fixtures 4 # Employees na AnYalteratron of 'h fhe8lea natural cond1t1o'jS I~ field or ::~ovedforthedram_ ~,- J u cernAnt ~O" u ,,, UIIS approval. - v.. "'1/ septic tank capacity, Zonrng RA Partltlonrng # MInimum reqUired structural setbacks, from Side exterior na , rnterlor property Irnes SpeCial I nstructlons none na Parcel # centerline of road, front 5' , rear property I rne na Parcel Size 45,'centerllne of road, 5' 103 x 120 Site Inspection # na Installation speclflcatlonslOOO exists Irneal feet of drarnfleld reqUired, max depth of trenches na SpeCial Instructions Properly abandon the old tank by pumping and filling 1t in. Place new tank as shown on the attached plot plan stamped approved and dated March 11, 1980. No change in drainfield required. Take care not to damage the existing drainfield during construction. Setbacks I nterlor property I rnes , ~rJge of road rlght-af-way IIdrng foundation Wells, other water sources CONSTRUCTION PERMITS/INSPECTION DIVISION , For rnformatlon call 687-4394, Susan gal mln Septic Tank , 10' 10' 5' 50' Drarnfleld 10' 10' 10' 100' For rnformatlon call 687-396Cbetween 8 00 - 9 00 am, Kathi M. Wiederhold SFD/ADD Type of Construction 5-N Group R-3 Fire Zone 3 Use ClaSSification Instructions See reverse side of permit for required called 1nspections. For plans rnformatlon call 687-3767 between 8 00 a m and 9 00 am, Jim Lamb For rnspectlons (see back of thiS permit) call 687-4065 between 8 00 a m and 5 00 p m Date Issued Directions to Site Turn on anderson off Cent. then turn right on Henco Loop. 03-14-80 C55-13 DEPARTMENT OF ENVIRONMENTAL MANAGEMENT COURTHOUSE I PUBLIC SERVICE BUILDING 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 By Roger L. McGuckin/lky / bne county @ 3 4 <:.... ~...c 6 .' , '. 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NO '~S':'h:jF\ It::S NO: BLD.GS .00"j [:,[, S ',1:, \l r;) i...lJ(I'""j" t (H~t.,. r. E E:' Di:~ 'Y" S.' } ~>~,;. ~,~ ~::) ,.:. . . '~.." '. ".<-;" " . , '. ", . '~~': ~~ ,~~..fO(" .,4.~{" ~::; 0 ;~:: 'r'. . ":.F.::NVH, JOltl,L. .- -, ".:"'- ~ .f'~ , ~ ' ,~. ( ,.~:;, {SO (:1 :3 fl :1 E () C; 1,,1 6,<:)'~5,i:a , .... '-'" F .~ ::. .' .;.. .' ..~ FEE'ii:'ii: "f"" ....~ .",:'-:. ," . ,~.~: ::~ :'; '"1''' ; '1,' ,~ . ~ ~;.' " ' ~\t ',,' .,..1" .. '" :3(> ~ ()O . . ~"~ (:) _~ (1 O..;.~ 1.1/ " U " . " ,. ,., '.,;"<4. A (.)J) . ~;o.,:oo, :2 ~:~ :. '(:J () 1 ~=;., 0 0 o (."-, ,', .. :l: . _,,~.~.(~)'.t. /) ();':.' ~ . ('j- () .~ y.). . !! ':i '?,r.:I..,(i, CI< . .'~' ~ J' ';'f' ;.~ iJ 12[, u ~ a . :. 11 10 . c a ',~ z " 9) ". '. , , ,&'~:~ :. , ; '1-' " t .7 c . " z .: ..;, ,~ '0 .Ill o ,,0 a c ,. ~O~\, DEPARHIENT OF ENVIRONt1ENTAL t1ANAGEMENT PSB, 125 EAST 8TH AVENUE EUGENE, OREGON 97401 Appl H:atlQl'l # ~-..~~.?-~O AS$19ned Number~ )'- Job Address / / / tJ /71 );,/1/ co? ;? t? P Clt,y E ///'-17# E l't)Wl'lSMlh/ Rante~ S~t1~n~ Tax lot -'-.7- CJ3 -d} 7-, ::r-3 - ~ 600 $ub41vHitll'l nn ,; /v I. l) P n J( K t.ot ~ Slack ---3 Appl1catlOn for /1.0/2; 'T,/dAI TCJ P.!lES';'A.-T #CJUf.!E Structures now on the property E:)l1 <( T/~";' /-Ioa,,;1:: Propo$ed U$~ (J-f !!,lVl'''' ty~ IPr a~~id$tja.1 CI ~...,.....rcial Aff1dav1t I, /2tJt~eR A. HI9RRIJoA./ [p.lease print) If th1S appl1cat1on 1S for an agr1cultural bU1ld1ng 1t w1ll be used for purposes allowed by the State BU1ld1ng Code and Lane County Code Chapter 10 (zon1ng) and for no other purpose I have the follow1ng legal 1nterest 1n the property owner of record, contract purchaser, lessee, holder of an exclus1ve optlOn to purchase, duly author1zed to act for the owner, who 1S knowledgeable of th1S appl1cat1on Slgnature/Address /? ,~'.~ ,::R r;:t2,.I-?? 4. ~_,_--.:... / //t!J /?I6/Vc",() ~,~ E-t'/'tf-6/vc '" -, . Pt ESSq';!i Telephone? y 7- ~ ,'l x-O or i,/Y-V-//Lr Date ~ - 7- J' 0 When perm1t 1S ready not1fy I.Y'Appl1cant () Owner CI Contractor !!l. Kma1l CI phone Owner tR~C.--61f AI HAI?I?/..$"d4J (ZlP) Phone Contractor (ZlP) Phone CI IMustria1 CI '~M k , hereby cert1fy that th1S 1nformat1on 1S true and accurate (ZlP) 9'/ ~dJ ,z. Contractor I s OSR# Plumb1ng by If Commerc1al Res1dent1al ., of $Wl"1ec:i , o.f be.d. ,,"""" SI test holes ready DO NOT WRITE BELOW THIS LINE # of employees f 1)f untts SOS: l~st1ng, BP # I~ Proposed, S1 # ~e r ~.~.. tOd~,e .' t)e$C1:'illt~'(ln /' , L2~. flof Sitt$ ~~-~ ~~ ,/,-,""j ~. .'..IA'~ _SL~. .A - //...// ' c1 A, . - ~~~~ .>//~f~- ~ 1Jflit tost Va 1 ua tlOn Fee Q C~S~ "/77 ,o..Qi~c~ f# /P"'- L/- ~ce1ved bX~ y{J,A /-k-I ~ . Subtotal $ $ $ $ $ each $ each $ $ $ $ $ 2&'" t::7CJ ...J.o - ] 'I. '. ~...'.. ,'="'"- la!J.../~_ ,+:- I. V.- /CJB )(" 1.20 rear_ .. S .... 4.:55 tJ Total Valuat10n $ Pluttlbing 1h:tltre~ at $ $ewer/water conn. at $ Water Supply Proposed Year Installed EX1st1ng 4% State surcharge / .~,~,:~:~c:~c~~:~~~ TOTAL PERMIT PROCESSING M1n1mum setbacks Zone ~ II- 1., front 4<~ /' Part # , 1., slde Parcel # /Y#-- , 1nt Parcel SlZe , ~" Comments To be typed on perm1t CP&I ,Type r'/l\J To be typed on perm1t GroupK:? F1re Zone / BY~ Date3-7-rP'i? Use Class1f1cat1on ~() . i - By M~ ~p, Date Phone '~,,(~,,~ For plans 1nformatlOn call (area 1nspector) DlrectlOnstos1teX "T'U/?N 4AI n IlJ /.n 6 /lr ~ rJ <(", /"I " .i<3 Plans to CP&I set(s) WPC set(s) A A./~ ~Pc< ,h.,xJ ..,;.::r <Z./l-~7 -rHeA' 7-L4P;l(,' .6)J~ d7 I-I SIFO ~I Ij/'WPC CI Pl annl ng CI Publ1C Works / CI Elevat10n ~ n/a CI Address CI Fac1l1ty Perm1t I~I Env1ronmental Health Date Requ1red Hold Sl1p to PCC Date Completed Da te to PCC -4Fltj~gy FOR INFOR~~TION about progress of your appl1cat1on call C74-171 Perm1t Control Center 687-HELP (687-4357) fL~~~'7~ '" <> . -to OEPARHIENT OF ENV I RONI1EIHAL t1ANAGEi~ENT PSB, 125 EAST 8TH AVENUE EUGENE, OREGON 97401 " Townsh1p, Range, Sect10n, Tax Lot Subd1V1s10n f'YIEJiltO PNj('K Appl1cat10n for r9 p'LJ ,I 7''' "AI Tt? ,<7 It ~S G~7 Structures now on the property E}i I ( T / A- (; /../.:> &f s,f Proposed use of property I~I Res1dent1al ~I Commerc1al Block AP.,Pl1cat10n # ~ f(! -t-5:3 ~()O Ass1gned Numbers ~ I I I l _ II ' I l...""~, I )'- Job Address ///0 m b/V~ 0 ? I"J 0;0 C1ty Glfrlr,../f;/l/E /7-t!J3-~ 7-:,::r-3 -~6oo Lot '7 AI c:u:~ f !E 3 ~I Industnal LI Publ1c Affldav1t I, /ltJt?eR A. H/"IRRI.$OA../ , hereby cert1fy that th1S 1nformatlOn 1S true and accurate (please pnnt) .~' If th1S appl1cat10n 1S for an agr1cultural bU11d1ng 1t w11l be used for purposes allowed by the State BU11d1ng Code and Lane County Code Chapter 10 (zon1ng) and for no other purpose I have the follow1ng legal 1nterest 1n the property owner of record, contract purchaser, lessee, holder of an exclus1ve optlOn to purchase, duly author1zed to act for the owner, who 1S knowledgeable of th1S appl1cat10n Slgnature/Address ~R ~ d.. ~...uM'''- _'. ///t::J /?/e-/l/t:() ~?'. G~"d-G/VE: (ZlP) 97 rYe?/ , _ 1'( 1:::$$ 4' ""~ e.. Telephone 7'1)~3.J..YO or~.s:.v-/I2-~ Date 3-?-aO When perm1t 1S ready not1fy I~' Appllcant I~I Owner I~I Contractor Qy ~~ma11 I~I phone Owner /ltJt:.-l5lf.# #.4I?RI.t't1.v (ZlP) Phone Con trac tor ( Z 1 p) Phone ~ Contractor's OSR# Plumblng by 00 NOT WRITE BELOW THIS LINE If Commerclal Resldent1al # of stones = of bedrooms SI test holes ready # of employees # of un1ts SDS la~stlng, BP # I~I Proposed, SI # Fee,. Sq Ft or Code ~ A" A' ~' Descr,lptlOn . r + r 12 /I, # of Sltes d~A9"/c.l...2l5~....a.?t~ ~~ tt--d2dJ"t'...--".,. -4 ~~.eu- /M,&-;r;--C 9-- ~ A c1, ,//' /7 /' ,,-:::r~/?:Z:v1 ..) //~~r~~A'JZ,..)- ~ Unlt Coot ValuatlOn Fee ,1nt . Parcel SlZe ..s:;- '" $ $ $ $ $ each $ each $ $ $ \ '$ $2G 0-0 '$~ IQ ,!.J..... L/J . f . /~i3 X"/:2.O' 4'-SS- tJ Total Valuatlon $ Plumblng flxtures at $ Sewer/water conn at $ ",,' r/ Cash _ ~/""Check #, rP2/7 7 ~celved by~~ """.~ y;2A..-a4'f-/ Subtota 1 d"''' ( Water Supply Proposed Year Installed EXlst1ng 4% State surcharge Pl ans check fee ,(I;1 Z f .encrrrge-of-tlcCttpaff€Y. r~Uf'.tL...,~~ TOTAL PERMIT PROCESSING M1n1mum setbacks Zone ~-+( l+- t, front 4',--.s-" / Pa rt # , t, slde Parcel # \ /J/ /J- , rear <_S ~ Comments To be typed on permlt ..., I'f? By Ail...A...4.--tfl-z. ~ Date L5-7-?'C? WATER POLLUTION iCONTROL t /600 .,.."" "" .... - '.. t Installatlon spec1flcat10ns To be typed on permlt lLlUJ ) / MAl j" /CJ , ltIA.e. aJLlJllJn1 dAcu .,) Telephone (j)?:!:1--3 01 rect lOns to S 1 teX '7'(4 R XI ,., ;'11 AI A/A t!!A' ~ .....;1..) fr? IS /lr .t 0 ~ t"') .0 /-' Plans to CP&I set(s) WPC set(s) max depth of trenches .k) hU-,~Wl~ t:U1r4 . Vi.- _ ""J 7 Db /I/~u, ifIk-f./ .,dJ.;/U4/Ibl /'M~ ' . By M.WUi ~r1Ii.i1lurt Da te t1I142AC/A 1'1 %lJ d.4=r ~ E...",..,., ":J-#6A/ 7"U~.AI AP&!!# //7 t'/AJ I-I SIFO --/ /.// CP&I -::../ I~I WPC CI Plann1ng ~I Publ1C Wocks / ~I El eva tlOn 'Iff; nl a Da te Requ1red Hold Sllp to PCC Da te Completed Da te to PCC ~I Address ~I Fac111ty Perm1t ~I Envlronmental Health ~-"I' J/- I U'2~gC:f~< FOR INFOR~~TION about progress of your appl1cat1on call Perm1t Control Center 687-HELP (687-4357) ..~ /' ....~ I' , . i ! ""~ ~ ~i w! I ;J: )" Me.il! r 1-1 2/' -~---~~-~---~---- Jl,Ot€' -Vv r ;0 .'l:c:'.4<.. €. fa (J Pt;I$ /?/./ ..~~~ L lVF.:~ II", TIJ~!'( 1000 (,I'}~, /_~ .. J C~R~vl- --t _1' ~ ......... ~~---"'*'-----~..r '(?c.1 ,. o"'tl ..........,...... r I f 01 I I I ft . ~ , I I ~/1~1 r J I '~... FV 15 ~v T ~IVI~ ~ If:' .::- N- r,.. ~ .AJ, /:J l 0+ 1/10 '--, I j ( ,I ,\ I /"-'iEAILo Lt) ,- , {1140J C lrt ~ C /J C I (':-J,\ ,"...4 _, .::. ;{ \,tI' -... '.... .::> ~ 1'1. ~ f 1 () - 0" 1(; ~ ...0... t rl <\ ,\l I 1J. \1 ~ I ~ o~ I I u.s ~ Y' t-'O j)1?/of3 WI'9-~ ---.......... APPROVED" . DATE Jj /I)j/J/Lfh ICJIl) nv ,--,J:1wJJ t" <-. '\ ~ \) ~ d\ C) ....... ~ ~ 1(.. t'- ~ ~ " "- " ~ Water Po11ut1on Control D1V1~ I j 125 East 8th j Pub11C SerV1C u11d1ng j Eugene, Ore. 687-4D61 RECORD OF EXISTING SYSTEM ~ K .. ' ~ '- " .;-' DIAGRAM /20' ~ ..:.- .. .. .>~ . - ....- " .I, II I ~\1.rz..~ III '/, -- ex ~c...'T \0C1l-nlM I I \. ft / ~-I ~Vle.s lJ.,vtt.V\OJJV1. I \ " evr::;;. o~r~V\ %or, t ~--.-~~ ~ ~do \~ o-1~~<'.J~? ,\ ,/ ~y,Q.S I 'I . ..shQJ.M OM-d I ~IJ~{,~ ~W r2.5~ ~~~~ 1 ~O-&s Ie,Q, h~() I '.11_ _ _ 'x\() \P (L, ~ .r. ~ Q " '): 'I -.c- 0-, ~ lr) ) : 0- o o --.J Nt'! r<.T\-l ------- ~~$' ~~~ o ---- s::. c) ~ 'I' '.... x ~.( ). r " , . ,- .. , " -- 17f) J ~- ......- '- 'N()TP; N('l1-Tn SCAlf= TWP. RANGE SECTION TAX LOT ~URnlVT~T()WPARTITION iW\(5JA/1-n- PtM~\tJ PARCEL """ - Loiql BLOCK --3 7 ZONING DESIGNATION ' - - _.' ~-_. OWNER 1<ln()1'- \JAC'rlSo'l\ ADDRESS vi \0 fYlp,v{lo Looo SJ",,{,'/lI1I11PPtf Q'7'117 EXISTING DwfLLING NUMBER OF BEDROOMS ~ PHONE 7'-(1- ~~~ - - IF NO DWELLING EXISTS, LAST KNOWN NUMBER OF BEDROOMS SERVED(FROM A&T RECORD) PREV IOUS SITE INSPECTIONS OR PERMITS -::n:.. I Li'G 8":l S-Iu /sq SEPTIC TANK SIZE fft~"'l:' GALLON CONCRETE fgJ METAL 0 FIBERGLASS 0 OTHER 0 LAST KNOWN PUMPING DATE If)ptltrnU!lY\ty?ci . GI'h....""tO CONDITION OF SEPTIC TANK: f SAT(sfACTORY 0 DISTRIBUTION ME-THOD' EQUAL ~ CONDITION OF DISTjDROP BOXES: SATISFACTORY ~ NUMBER OF LINES ~ LENGTH EACH LINE 1 )(oeJ-(P/~ ft. 2) (o~-/teb ft. 3) 5) ft. 6) ft CONDIDTlON OF FIELD: SATISFACTORY 12(1 UNSATISFACTORY 0 Cp.MMENTS ~Y,;<dvlIlll SO(. QJ:flPO~~ ~ bOj;)Mtrh/M/;'/,P f1~</jJA." LfL eJJfJIl5rufA~ ~d;;1YJ 0p tf)JfYlo~dJAl1kp!J11I1i-Viro IhIL}}btJ.../L V!u (fnMY-1(/4()b(lY ?JiD= Ijy~b0b~ FINDINGS 1) Th1S system lS 1n compl1ance w1th prov1s1ons of Oregon Adm1n1strat1ve Rules, chapter 340, d1v1S1on 7 and lS slzed to accept a sewage flow of up to t(~ qa1lons per day. 2) Th1S system lS not 1n comp11ance w1th one or more prov1sions of Oregon Admin1strat1ve Rules, chapter 340, d1vis1on 7. UNSATISFACTORY [] SERIAL OTHER 0 (SEE COMMENTS) UNSATISFACTORY [J ft. 4) ft M74-176 ~/n, III 1'7-fdJ/!,hl)frI -Lt/ &./ /77 IJAll:.U I j)~ . 10~ 61 c:/) \ 013 1.-/./;19 _.._--:::.- ..:::;rT :3 -J \ p~ \CJ" \~ -\\J"\ ~~~ --\- 1k' ,.~ 0tr~ ~C? ~o\ \ \ ) ?(,/ \ II -' ~' 4- tf14d-QO ..j~ '- ~ \\'vt -' '~ \ I'" ~ \>\ ~,1 rj&-<e4 ~ ~ ~ ~ ~' \ ~ - ~ s, f? f+ I Y 5 2l ~ p- t Lt ~ ~ 0 85' fq' ..u. 58;05~-' //1/ 86 15'~ ~.i/; ~D olq 'J. 1 \1}?-~O'Y..j o it; ?1~ :---;;:/( ~ -Cfq (, ----- ~.- 3'50 ---- 7 -t-- :t I '-i.,;1 q 5 S' - ~--- ,,"'5 ~o -3': __ ..:3'~ ~ "'>7: "S7 '-S' V'~ ~ ..~ ,\S' '<'~" ,_ P 15410 s:l oj>. - ~'~- "'" ,~ \jo." " 3,ZO" v ~, :..- 0 \J ;./ I -r" ') \ y';pt. \\ J /~~ /: ~0 ..f. ~lr c.f~' c:.o' 5.0 \ 0 \; ,,~ '!/'/. ' 00 ~ \~ 1 ,z.1> ~c, ~Jt \0 \~ /i <1 \-- Ft/S40'J 4'" S"",f' .1;:;< t4 ..~ \fe" . /,' yo. '. .~o ~1-Jc" .:,J II'~ ~~<o. o"'~ ci .,&,,0 ~\ '~'O DC'>'" ~'\O 0 ~;'.:,J c,1' 'tv In '" -1-+ 0 ( (}. ,,0 \ /o~ ",_:Y -H' J 4 I d- q.. "S'~' ,,;: ..,. 8 '" 0 " " ;~ -:::r- .'\10 ~ ~() ~~s-~ ~ ~ / s-~. ~ <' o. I-'f/ t+lkf;LP~ r I k~ (,\J\ (0\ N~s?9./3' J/3~ / / 3o~ 't';~ IV "'" . C)\> \)\l - r:::,: ,"J I _. 8598' NWIr- 4<)' IIS:'5 w Q~ ~ ~ N 8q~~~~O"W _ _ _ --T- N710 1-1)/ qq (,Z' , --- -:.. 54 G ~ 1c ~i 9'1';'?.':'; .',\ '-\' " \ ~ /0 \ \ \':;;> \ ~- ICl:J -\~ ~ ll;-- ~ ~ /1 ~ - ~ ~ ~ 0-../ '- >' 6,PP:IY 'dii (.,2 25' I '" tr1 ~.f'?' tV -* I 0 :;u;"'t ,I I(J'''' f , -. ' I c" fJ" I 'J /2 ~ commISSIoner '.# C omfTlf5SIoner i\ .~I , If ft) II ~ '\ t rvC \ {J o ~ o AI ~I" zt'v/ ~ SCALE I" = 5 4:50 37' zoo"'; 2000 Assessor commisSioner 1:-1f1 v , ~ C...9<.,L " 0,..... .""- .~~, ;>'-- ,fly L - \" '{' AIJ~ , I \ \ \ \ \ \ , f r I / \ 60' - surveyor C h 0 " man. Lone Co Plonn<Og commisSion 5ecreIO'Y' Lone Co Planning commiSSIon ~ 3S'O t I 4- 0 100 ~ 13'dO state of oregon} county of Lane 5 5 I, J oh n LOu ,Jlo, J'. being duly swo' n. depOse. on d soy IhOl IhlS IS on exocl copy of Menlo Po ,k '1 5~C 27 T 17 5 , .3 W W M , Lone CounlY, o,egon. ~ ~ ~ - 5 u bSC" be don d swo,n 10 be,;,!e me I hiS S Ih daY of /I". · r<. L /' pi - +--~~~ ~~ ", , --- ,1 I ..... .!... 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":;-; _,~;.-;(~. c..'.d, ....J6~ ~ ..:.~'~ ~ ------.--..--- -~'-- -' .--- --- ",-"- . TRS, -n 1-?-03-d7D 3.0 ~ *.;;)~CO VICINITY MAP (, ~ \1..1' I v: i <l: .,) ~ ~ ~ j' :z. y ~ R S /J EAJ .s 7 I '( . -, ~J-rJ-? ~~- Lot___' Block.~ -. FOR SANITARIAN'S USE ONLY ~ System Approved 0 System Disapproved ~ ~~ ~r~~ COMMENTS ~: ~raC&YJevrf ~ ~c:.. ~---Ib ~e. Cldddu/IA.JAVa ~ ~c ,~ ~ -fop ~..Ju 1oo1<fr!it ,00rMA I (Q~ iMtesf>auy ~ct 02~<(b CLD ~PnOYtQ C~g\~1~lfe'~J V1/\ (Af1PrJiA/;]t4r! Date(')~ FOR INSTALLER'S USE Trench Depth Filier Depth Below Tile \j DC. odS ~/1-~L Tank Capaclty~t7t)t':Al. Manufacturer ~X"rEJ? ~/"tPn~~LA.rS' .,lA/c. /JHIE6-i',i(/ Measured distance to well from tank from dralnfleld Job Location (Street, mile post) /1) CJ '---1'Y71~ hie h'~<?) J?hI?I< SubdivIsion PLOT PLAN -) 110 fle.e~ ~""T 1../ () t.t ~ ~ ~~ r, , <( ~o , ~~ ,.,j I ~ ~ ~ ~ < [' ~ " . ~ ~ , ~ w ~ ~ ),a: ~ ~i \ OJ ~, r'- c - ~/(l \- co ~ ~ ~ ~ ~ ] ~ ~, Scale \\: ~~ ~ J~~~~ OJ l!~~ . co +-' Q. -, :jj: '" > Q. , c.. c co <( co N Jl,r;..tAJ ~ 1'100/ r/ollV _~P./9 T/O . -n.,J I:; w- ~V"...\I s cP '1'1 ~ ~~ t'1'lA; K ~-;:J I,()DO 6'lIt J.~ I n nOf\.Ir;.~ ... Ig'lz U1 fI , I I 1- ~~ I S 1'/~ /)Il. 4J,v I PI I;../,,() 19 ~ P 7"'1;Hv S F--lilf JJ a X '-~ ...- ~ :P 'C' \ L~V ~ (") .z. f~.)~ r- 0 ~ -;0 -;.~ ~ ~ ~ tV '---=u4 - (0 <2- "1J cP ~ -2 ~ ~ ~ .-> :p~=;;;g - CS Vi d'.,o ~7 Q:gg<{5~ a <\J 9.> 1<1\ 5? INSTALLATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION When signed by the Gounty Sanitarian, thiS certificate IS eVidence as per ORS 454 665 of sat- Isfactory completion of a subsurface sewage disposal system at the above location Return thiS form to Permit Processing Section, Department of EnVironmental Management, PubliC Service BUilding, 125 East 8th Avenue, Eugene 97401 C5511