HomeMy WebLinkAboutPermit Septic Tank 1991-2-20
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Permit No. ~v. - / Twnshp. .' '7 Range D-3 . Sectjon 33. /(. Tax lot ..200
Standard System 0 Alternative Sy~tem 0 (SpecilY Type) R~ ID cQ~'() ladle., <
Job location (Street Address) 0.;l An tI@ r$Or1 A.V1 ;)r-Pd r
Supdivision/Partition # Parcel lot
DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED
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USE BLAGK INK ONLY. . .'
FOR INSTAllER:S USE: t. Trench Depth , ~lf+l"'-j Gravel Depth Below Tile J2X1s-fli.~U ..
Tank Capacity 1000 "i~' Manufacturer jMl/~.j{~ G<<-ey~./;. ~ ~
Measured Distance frorf(Well to Tank 4 0 From Drair1tield . .3 J Total length of Lines e.)q~f/Y1c
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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. .
Signature. . Date
FOR SANITARIAN'S USE ONLY:
COMMENTS:
~stem Approved
o Needs Correction
o System Disapproved
. 2. Sys!pm Corrected Date
System Capacity 41""\ 7) gal./day Signature -->;:/,_ ~~ ~ Date;2. ..... ;)... 0 - ~ /
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY eOMPLETION When sl(g~ed by the eounty 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 of this form to: Lane eounty Environmental Health Services, located in the basement of the
Public Service Building, 125 E. 8th Avenue, Eugene, OR 97401.