HomeMy WebLinkAboutPermit Septic Tank 1993-12-15
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DEe 151993
i==Nv I LANE COUNTY
tre II t"JQ 7 - RONMENTAl HEALTH
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./1 1 7S(' 9 ~ MUST BE IN BLACK Il-JK
Permit No, 7~ I U - ~ Twnshp, --L7 Range 6J.3 _ Section 39 I). .2
Standard System 0 Alternative System [] (Specify Type) K~I>t:lJ.'1' r\
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DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED
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USE BLACK INK ONLY ,
FOR INSTAllER'S USE: Trench Depth :; y. 'I' Gravel Depth Belowlile ,'"
Tank Capacity Jt'J(JO Manufacturer f1' 6 ra TeV(
Measured Distance from Well to Tank, - From Drainfield, - Total length of Lines /SO"
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 US,E ONLY ~te: Appr~ved Ji2J Syst~m Dis\lIlproved 0 Ne~~~n
CO~MENTS:... A"~'~ j' ~,,'7J-- r~ ~ -a,. ?d...
~ A~_JJ_A, ~ ~O.A'k.._
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o System Corrected Date,
System Capacity 4/.5b gal./day Signature _~ ~_ Date /.:2-IS- 'i..3
INSTAllATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When SignedU'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 of this form to: lane County Environmental Health Services, located in the basement of the
Public Service Building. 125 E, 8th Avenue. Eugene, OR 97401,