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HomeMy WebLinkAboutPermit Septic Tank 1996-8-15 ,\ .U~/U~/~b 1~;14 , ,.\ ~: ,,' \ :-- U:>UJ ., 40 .l5:1U :; ~ (;/\.1'1 ti l,.:UKt' )FrEHJED U/6 IaJ 004 $ t\UG 'J 51998 (Date received) ,1 '. l,L.. ........ '_: '.... ..,.. ~ I , , SEWAGE DISPOSAWSi\f$'J1EM,j"AS,iBWIL r' PLAN / .............talfw_:, _""--'OAlus..B6~.Of\R:J04G.7t-170_0M~'-tn.-."".,,_..~---aaJSInoliIy_J..,, <11.. - ..to";iry(cr ..... ,..,.J~__.......an.dior\_.....-<4..,.,....faf_.--_e.-lis.. , .,..1~1DI'the~<<". ,,' .a1....."..1bIIIDn). n..: ~COl........-J_-[1ldov1tDperl'"",,"".,,. ,.", dlbe~--*"'...Illa-n0ciQ8-.-Ihe., .,.,.. - fO<~-I.i_- ~_.." . " ,_.,..,...,tDlla_~. ReclBipt_~dlhis~"""",,,,~{crAgenQ -"., -, ,~, ...._ntlIIc8_...,..... ....~....u.........,., ,~.l!lllaJIl..,,;' .1_E!!!!!~f.,...:,'il'.d.~-\I>I_~,.".,_. BlI:1l;!oIh ''25E..~,.,___~o....a..97~ SEcnON'1: BASIC INFORMAllON Permit # 2851- 9' MapITax Lot # 17- 0.3 -1.3 7J.,. &:,0 2- Jo Be comOtetedBV.lnsta1Ie(: . . ' 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 SF''''ii:JI.\ . t , '-- " WATER SUPPLY: . pUBLIC 0 Individual 0 Community a Other (Name) / 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 ~~' I , OrnER: (Materials not fisted above), ,Date ?J~A6' I I ~..&"&~4#~~&&&4.#.&4A.~.A FOR SANlTARIAN-s USE ONLY: x..SystemA,~r':"~"'-o S}.:ol.."". Disapproved 0 NeedsCorrection COMMENTI): qaVday (over) ,.' ~ I , ~ \~;,; -,'j _. :,,:;~",. ,:.. ....,..~... \ i I ,..(, ,,;>1( ,.. ( '^1 '- ~i, UlS/Ul:l/~t) 1:);1:' SECTION 3: UbV;j 'I 4ti ;::5~u :>H':i!.l'l lJ CUKt' ~OU5 . (ovel") 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.. .........~.._......~..*.....*.....*.._***...........w. ~ _...~ ~*........*****....*****...._*...*-_. '. II ... . ;" I ""; ~ $ )... ~ ~ . -'*'"***........... . VICINI1"\' MAP .~ N ~ W ~l ~ ~\ -S '>- ~ '-J ~ ~. " '.~ r ~ 'i:~~:.;..'"' ~ --- ( C;V --- p~LI~ , I I rJi;' $V . ~ 'I n' , 51>' ( , $1)' Iii,)) - S1>' r .f If/ f - ')iJ - ~ / ~ S I p.~,,- : ~i.- 10 . ~'\)t ~'-\i~iI'{- , ~ ~ -;\~ ) , " "}- l ' f - ... , ........" 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 t..:..,;.,....e Na. '~I}.;:78- ' , ' '" _ Bonding CospparlY CoAhtAcnR < ~P(JJ b ..f ;F.N5. '\,4, Sigo~ure ~~~ "':'" ....