1314 MAIN ST.PDF11111111111111
14202
1314 MAIN ST
SEWAGE DISPOSAL PERMIT
Septic Tank .......... .. ......gals. CITY OF E D M O N D S No. ....••..
Disp. Field .............:.............sq. ft. Department of Public Works
Other.................................................
Name..------..... .......-1n2..:. ...------------------------------ is hereby authorized to ilvAaW
repair sewage disposal system at
Date issued on •.. ......-:...:.....r...... lrr.,�......--••----
Permit expires one year from date of issue
DO NOT COVER BEFORE APPROVED BY DESIGNER OR SANITARIAN
I hereby certify this system was installed under my supervision and control and complies with all provisions of the City
of Edmonds Resolutions.
Signatureof Installer --- ......... ---------------------------------------------------------- Date ..................................
ApprovedDisapproved Date.....................................................:......... By ...................................................................................
Remarks: ................................................................................................ •---------------------------------------------........................................--------....--------......
SANITARIANOR DESIGNER ------------------------------------------------------------------------------------------------ Date---..........................--------------...
This permit shall be posted in a reasonably conspicuous place on the job until inspection has been completed.
CITY OF EDMONDS
i DEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, Edmonds, Washington
SEPTIC TANK INSTALLATION PLAN
(Subnat in Triplicate)
Trriplicate)
�,��7 -A-051 I f' ------------- -. ---------- Lot No..-----------.......... Permit No.....F../..../.
ADDRESS OF,P�ROPERT�Y-----.L.............. ..... ....... ...................
Owner ---- �------- Address....//.'Z..................... ............... Phone--------......
Builder_-. ---- ....... .......... ... Address..................... . ---- .. --- -- .-- ...............------ Phone----.......---........--
er-...../C../±�J /• ...-...... ..-. Address-- ----- - .............................................. Phone ........................
L T/G� p rr�� o�FHr
Installer--/!llO..L/Q Address.P.eot.�.. .. /........ phone .....
I hereby certify the accompanying drawing is an accurate representation of the system installed at the listed
address. I also certify all recommendations and restrictions (concerning plumbing stub elevations, maintenance of
grades, fills, surface drains, etc.) listed by me on my sewage disposal system permit application dated... ... .........
.......... ...have been complied with.
C jib/ ��
Sip�tatsisur Date
TO BE FILLED IN BY CITY ENGINEER ONLY
r
Accepted.... .:/...'......... ...... ..... ................ •-• llate........// el - %...
Not Accepted .. . ........ Date. .......... _.. _................
Signatureof Sanitarian........................................................................................
Remarks- ----------------- - ----------------------------------------.---.....---------.....-.----------------------------------------------------------
INSTRUCTIONS: Use the reverse side of this form for the drawing. Use a scale which will permit the greatest
detail and still contain the entire site on one page.
ATTENTION HOME OWNER:
Your septic tank has limitations! It was designed and installed to care for an average -size family. Over-
loading the septic tank or disturbance of the drain -field may seriously impair satisfactory operation. Points to
remember:
1. Have your tank checked periodically to see if pumping is necessary (2%2-3 years).
2. Do not channel ground water, surface water, footing drains or downspouts into the tank or drainfield.
3. Do not excavate, fill, place a structure, driveway or. patio in, on, or over the drainfield.
4. Limit toilet fixture disposal to sanitary wastes and toilet tissue.
5. Detergents and bleaches used in normal household quantities will not harm the action of the septic tank and
disposal field.
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CITY OF EDMONDS
DEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, Edmonds, Washington
APPLICATION FOR A SEWAGE DISPOSAL SYSTEM PERMIT
(Submit 3 Copies)
Permit to be issued to: ik !.. -----_......... ...._ K N '1 h i, .. ...........
For installation at: (street address) - - r A. } t�"...--•............................`.......
Additionor Subdivision ..................... -............................................ .............. . ----------------- Lot------------.... Block ................
Type of Building: New..........-- Existing.-.. '..-.. Single family residence ................ Number of bedrooms........ #................
Other: (specify type or use) , j _ ",. . y- & k.. ` ----- .._...... t� .................�-....-�--�---------
Builder-------------------------------------------------------------------- ----- ------------Address...------------- ------------ ----------------------....--•--............
Designer----- -- ------- -- - -- ------------------- -- --- --------------- -- --------Address.--- ................................ ,... --• ...... ..............................
Soil Log Hole No. 1.... -- �� ------
..�.....
Soil Log Hole No. 2...s'= +�°f�.-.. �. '.t�"'.e ram`"ice '....... A ...... '4& .e?�e ............
----------------------- /... ply �f Apo �j,................... ..........
.....
e-V
Elevation of Water Table, if encountered. (Distance from ground surface) � .. .. V..... ..............
Corrections to control surface water if needed..................................................................... ...........................
Specify if any removing or grading of topsoil in field area.....................................................................................................
--------------------
Percolation :
Test Hole No. 1 —Average Rate ..................................... ..... . . (Fall in minutes/inch-bottom 6" test hole)
Test Hole No. 2—Average Rate ........................................................ (Fall in minutes/inch-bottom- 6" test hole)
Test Hole No. 3—Average Rate ....................... ...... (Fall in minutes/inch-bottom 6" test hole)
Average percolation rate on which to base drain field design .. Date Taken . ................
Septic tank requirements based on present rules and regulations:
Septic Tank Size......_-5.0....... gallons.
Amount of Square Feet of Disposal Field ..................................
Signature — Designer' G ...... = .. o..
------------------------------ -. Date.. .: a.... = ;:....:.. d
DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
Permit issued (date)...' .:. . ../-�--- ---� Permit Number.... .7.../. .........................
Remarks:_
----
-------•--------------------------------------•-----------------------...---------------------------...----- •---------------------•-----•----------..................-•----.---------------•-----....--
CITY OF EDMONDS
DEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, Edmonds, Washington
SEPTIC TANK INSTALLATION PLAN
(Submit ing�Triplicate) s�
ADDRESS OF PROPERTY ...... .------....................................... .- Lot No ................. ...... Permit No ..... .1---..........-.
Owner_.. f_. /...-�� !®-! Address ..- ._s .v Phone -
..... . .........
Builder ..------ /.A-1a11/UW.�l....... ._ ------ .... Address .----------- ..- -------------------------------------- ._. Phone...---------------------
......""t 'ef / --- ---- --- - .- Address------------- ----------------- --- ------------------------------- Phone--------------------- -•
Installer__:-a✓�?/2'.5+�-/�-*'---- .-.��.
----- -----• Address.-..�!. - --.f.�.:.......-. I4hone...................
I hereby certify the accompanying drawing is an accurate representation of the system installed at the listed
address. I also certify all recommendations and restrictions (concerning plumbing stub elevations, maintenance of
grades, fills, surface drains, etc.) listed by me on my sewage disposal system permit application dated_ ..............
............................................have been complied with.
..................
S' r Date
TO BE FILLED IN BY CITY ENGINEER ONLY
Accepted---- _ ............... ............. .. •--- . Date..----// _;- -- ---...
NotAccepted ......................... --. Date.......................................
Signature of Sanitarian....-- ..... ... ........ I .. ..... .--_ •--------
Remarks:. ............. ..........•--------------•-------------...............--•--------.................. ............ .............. --•-•
d
INSTRUCTIONS: Use the reverse side of this form for the drawing. Use a scale which will permit the greatest
detail and still contain the entire site on one page.
ATTENTION HOME OWNER:
Your septic tank has limitations! It was designed and installed to care for an average -size family. Over-
loading the septic tank or disturbance of the drain -field may seriously impair satisfactory operation. Points to
remember:
1. Have your tank checked periodically to see if pumping is necessary (2%s-3 years).
2. Do not channel ground water, surface water, footing drains or downspouts into the tank or drainfield.
3. Do not excavate, fill, place a structure, driveway or. patio in, on, or over the drainfield.
4. Limit toilet fixture disposal to sanitary wastes and toilet tissue.
5. Detergents and bleaches used in normal household quantities will not harm the action of the septic tank and
disposal field.