HomeMy WebLinkAboutPermit Septic Tank 1996-8-15
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SEcnON'1: BASIC INFORMAllON
Permit # 2851- 9'
MapITax Lot # 17- 0.3 -1.3 7J.,. &:,0 2-
Jo Be comOtetedBV.lnsta1Ie(: .
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PERMIT ISSUED TO:
. Name: ~ CAn .B C}..ro Mailing Address: 'y/OS' .&JJf lt~~
Property Address: . :13 '33" ~/Jv. ~A) k. Sfl"'t"".~~. '
TOTAl #: Bedrooms' liVing Units BaseOlf!nt Yes' No
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WATER SUPPLY: . pUBLIC 0 Individual 0 Community a Other (Name)
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SECTION 2: Materia~~ List (Identify and list all materials used in Systf~rriS;
SEPTIC TANK:, f!:. Concrete 0 Poly D Metal ,". '
Manufacturer (Jr/!t'l'f.p1!€ GR.AY<-,vJ& Total UquidCapacity lOW _/ gal.
Distance ;, v. u OyveIling -h ft.;' Effluent Sewer ASTM # .; .Distance from well ft.
DRAlNFIELO: '.:
Total Linear Feet SfJO ; Drainfield Pipe (AS1M#)' ; Header Pipe (ASTM#)
Depth Rock Beneath Drain tine in.; Depth Rock OVer Drain Line In.
Distance of WELL from Closest Portion of DRAlNFIELD A)JNt .
.' Mfg.lrypelSize Of Rock Fifter Mate~aI-:t:"A 1hL7R.A~
PUMP S'r ~I c.lIl:
I (i.~~ller's name),' certify that a . ,
(Mfg.)' Model No.. .Pump and Mercury Roal
Switch (Mfg. and No.) ~ave been installed with this sewage i...,lcJlation.
(Complete 3S Applicable): Working ea...-';iy ~f Chamber qat Gallons per Cycle qat
"'Working Capacity" remaining after alann has acth.~h. J gat
Signature ~~'
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, OrnER: (Materials not fisted above),
,Date
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FOR SANlTARIAN-s USE ONLY: x..SystemA,~r':"~"'-o S}.:ol.."". Disapproved 0 NeedsCorrection
COMMENTI):
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SECTION 3:
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Permit # .:23~f - 9t,
A~U(L T PLAN OF THE CONSTRUCTED SYSTEM. Show the following: North arrow. septic system
refeienoed fo a fixed point, such as, builcfln9 foundation Of' property OOmef'. P.,........,..ly lines. wells and water lines
within 200 ft, drive Of' walk-ways. all ~jldiogs. po........sty di.........,ions; ~ .:;.0....". t' -,;...:.,., cuts. esca i ,.."'1 I. ...nts (>50%
slopes). ff!CkJde ooalgrade shots of ends of l..;,....J.es. d~,-l...llion boX. and SqA;.... tank otiuet elevation..
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I certify the in)", ,atOO prQVided in this notice is correct.
and that th6 constJ1!ction .of this system, was in accordance .
with the Permit and the rules regulating tt.e crinstrucf,ionof
an on-site sewage dispoSal system. I have tested the
septic tank for water tightness pei- OAR 340-73-025(3) and
found it to comply.
1~ller (please priot)fl~)7Ae (c}J~T ~ ~ ')":'>>(.
(Tl\1e as shown on DEQ r~l Uhr-? /
Telephone S'V/ - ~8r- 1 p 7
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Bonding CospparlY CoAhtAcnR < ~P(JJ b ..f ;F.N5. '\,4,
Sigo~ure ~~~
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