HomeMy WebLinkAboutMiscellaneous Plans 1991-11-19
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-0 MUST BE IN BLACK INK
Permit No. 3J7(P /1 Twnshp. /'if'" Range ~ Sectig", e,{2. 2-
Standard System ~Alternative System 0 ~SpeCif'i. Type) #;l) tL,DM.,..,.f tf..
Job Location (Street Address)-Q7../ 0 ,~<:'+. ~fr'...". P.~ {J
Supdivision/Partition # Parcel Y Lot
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form c55-,..tl
Tax Lot_/70 cJ_
Block
DETAIL SYSTEM PLOf PLAN AS CONSTRUCTED
If It. 1 I 11.. S I j .. -10
::[I-!Au-f pvr~4't ::US~tC~ . cae =
5'1 sf.ott-t .s 1/0(.<.""'1 ;11'"(1)< ,1 ttld.. ~
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fl'4>1Ce w/~ pra~is~;;'.:~ d/ .
cuft!. '6'11 ---r:;>'l/i S{~ 71
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USE BLAFK INK ONLY / "
FOR INSTALLER'S USE: Trench Depth :!. </' Gra)lel Depth Below Tile ~
Tank Capacity /000.,r>t Manufacturer. C",.._,.,." ""=>___I?.. .
Measured Distance from Well to Tank <"<:. r ,From Drainfield 70 ( Total Length of Lines =<: o~
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I (installer's name) certify that a (Mfg.) (Model No.) Pump
and Mercury Float Switch (Mfg. and No.) have been installed with this sewage installation.
Signaturp . Datp
FOR SANITARIAN'S,US. ~ ONLY: --/.~, s.r~eZ::=1t.,d~ ~SJt!:,m Disa~ 0 Needs Cmrection
COM.MENTS: -. . /fhV' ~A"..< _.' .1'...,.,........ ~~
-- A~'t!~~;;; .-....:~ JA--r..., . ,,;r- f ~;::ep -tf,.'-A1 ___~
P' L~System.Aorrected Datp
System Capacity 'f~-tJ gal./day Signature,... ~~. ..~ Date_I/-r"'--c:..fl
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When Sig"~y the County Sanitarian, this certificate is evi~
dence as per ORS 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.