1602 MAIN ST.PDF11111111111111
14210
1602 MAIN ST
0 •
SEWAGE DISPOSAL PERMIT
Septic Tank ......... V ---..--gals.
Disp. Field ........... /0.0....... sq. ft.
Other
CITY OF EDMONDS
Department of Public Works
No. ---/-, /-----------
a
Name...............•.._......rl�---
. etez.41 .......... .1� �l-'L r X ---- --------••-----------•-------is hereby authorized to install/
/ repair sewage disposal system at
Date issued on ............. %.----..%:-.
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.
Signature of Installer---------------.
t
Approved Disapproved 0`<'. Lmte--------------------------------------- --------
Remarks:
..................... _............................... Date ..................................
-- By..................................................................................
SANITARIANOR DESIGNER----{-- ....-------------------------------------------•--......------••------------------.... Date ..........................................................
This permit shall be posted in a reasonably conspicuous place on the job until inspection has been completed.
CITY OF EDMONDS
-"E ' F E
ST
DEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, Edmonds, Washington
SEPTIC TANK INSTALLATION PLAN
(Subinit in Triplicate)
ADDRESS OF PROPERTY ................. 1(RM........ 1/ /.�t�S!J../.�7�5 -`--'"-'---'..... Lot No ....................... Permit No...-,�`. .---
Owner -....Ap�/--LopP�¢�.. Address.. T/eLtJ Phone.....
Builder. Address Address. - Phone
Designers. /f GC�'1 Address .............. .............................................. Phone------------------------
Installer.. .- `�u...�a �C Address . .......................... .. .......................... Phone......---------......---
I here v 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.
.................... ------------------------------------------------------------------------------------------------------
Signature of Designer Date
ll TO BE FILLED IN BY CITY ENGINEER LY
/1,... llate... 2,Q
Accepted ................ --- ..2 ...------...... ........
Not
Signature of
..... . V.
. ... ... . . ...... Date
anitarian ...............................
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%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 Karin the action of the septic tank and
disposal field.
CITY OF EDMONDS
DEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, Edmonds, Washington
SEPTIC TANK INSTALLATION PLAN
(Submit in Triplicate)
ADDRESS OF PROPERTY .................141.0e0........Lot No ....................... Permit No.---� ....
�y � d /
Owner. 9.�. .. .. �.� Address .... � ....! .,� .-.. � t.�s t � 1 Phone------------------------
Builder 4...�g
.<-..r,"�_k,, .es ... ^,?✓ � �/ Address. ..... - ----.......................... Phone.............----------
Designer.....- . C+W!co.e.d.... C114 Address...... ............ ._..------.....------------------------- Phone---------------------...
Installer.. �e%ter rr�ze�.. .a -s _ Address ................................................................. --- 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.
----------------------------------------------------------------------------------------------------------------------------
Signature of Designer Date
TO BE FILLED IN BY CITY ENGINEER ONLY a
Accepted..... ....... ............................................... Date..........-... ..-..��
Not Accepte .. Date........ - ---------- -----------------
Signature ofSanitarian........................................................................................
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/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.
•
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: ----------- C•....... ..........� .0 Q 114. o
For installation at: (street address)-. ........ .14.. .._...-.._....... _rA� ........... � ..!�.....: c.:.......................
`V I
Addition or Subdivision-------- l�J� �.....--.... �. Low c ,
Type of Building: New ..... Y.... Existing ............ Single family residence ✓.... Number of bedrooms......._..�.............
...
/? je ? �
Other: (specify type or use)
Builder.. _s_t..�e.r tt. _e e::Address....._...`r���.-...----- Re..(A....-f ,. :Q._-�..4....
Designer ---------- 0—_,........ ----._(�70.4.1L..a. f.v/.. Address ......... 7`'l!- ............ �a ^ �...i...-_
Soil Log Hole No. L---------...................................................
SoilLog Hole No. 2 ------------------------------------------------------------------------------ ------------------------------------------------------------------------------
Elevation of Water Table, if encountered. (Distance from ground surface) .......................................
Corrections to control surface water if needed --------------------- -------------------•----------------------•------.................................................
Specify if any removing or grading of topsoil in field area.....................................................................................................
............................................................................................................................ ------.........................-•---.....---•-•-•--.........................
Percolation: /I 1
n
Test Hole No. 1 —Average Rate.......... 1..N...........1'... Fall in minutes/inch-bottom 6" test hole)
Test Hole No. 2—Average Rate......... L&P:.........P. (Fall in minutes/inch-bottom 6" test hole)
Test Hole No. 3—Average Rate.......... ...4,,./_.... ..(Fall in minute�/inc -bottom 6" test hole)
Average percolation rate on which to base drain field d�sign
�}./.. to Taker�.�....�.
Septic tank requirements based on present rules and regulations:
Septic Tank Size._.. ..... .�%� ....._gallons.
Amount of Square
Signature — Designer...
Date..... ......
DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
Permit issued (date). ....... ------_------Permit Number.- ---- C�........................ ,
Remarks:......................................................... •••---