19220 93RD PL W.PDFiiiiiiii lill
9067
19220 93RD PL W
a
TAX ACCOUNTIPARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
DETERMINATION: E] Conditional Waiver E] Study Required E] Waiver
LID
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED: 4 /
SIDE SEWER PERMIT(S).#:_
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
LATEMP\DSrs\Fortm\Street He Checklist.doc
, 'I -
.17 C. 16
V
PERMIT NO: 9261
City of Edmonds : PERMIT EXP . IRES--5j7/n(
SIDE SEWER PERMIT
Address of Construction: Y3 A -44_.) LID #
Property Tax Account Parcel No. co co
Attach copies of all access and utility easements Verified and Approved by FEF 0
Owner and/or Contractor: 6pwA-V4.*5 144-S
tB d I LWV -
Contractor L . icense #: 40.wAtWX S 911 —Building Permit 3bC VVO . Mb UEEM
!RrSingle Family
F� Multi -Family (No. of Units
F� Commercial (No. of Units
Invasion into City *Right -of Way: E] Yes P'No
*RW Construction. -Permit #
Cross other "Private Property: El Yes No
Fj Public "Attach legal description and copy of recorded easement.
-7
Owner/Contractor ;;2
Owner or contractor signature and ackn—owledgement statement: Date-'
By signing for this permit I cenify that I have read the City's public handout entitled
ide Sewer Specifi6ation's, and shall comply with all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION W
FOR INSPECTION CALL 425-771-0220 extension
HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
........................... ............ ......
..................
FOR OFFICE USE ONLY
Permit Fee $ _20 Repair Fee $ '2,5-4 Issued By: \-Q_ Vx- a=
Trunk Charge $ Date Issued: r-,-)
Assessment Fee $ Receipt No:
City Permit Surcharge Fee $5.00 Total Fees Paid $ s::
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO Date: Initial:
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date:
Initial: C_0_J CAs-built to Street File:
1� PERMIT MUST BE POSTED ON JOB SITE t-
White Copy: File Green Copy: Inspector Bu,ff Copy: Applicant
L;temp;bldg;forms,sspennitjlg4/00
Not
New* PVC
was instatted
f rom Main
Sewer Line to
fence at
property tine
+>
U
0�
z
0
co
6' PVC c/o
T 4'
-141
Driveway
CL
75
Existing 4'
m
Concrete
U
6 X 4 Conne�tlon
4' deep
0
CITY OF EDMONDS
SIDE SEWER AS
-BUILT
ADDRESS
19220 93rd
P1 W
PERMIT
NUMBER 9261
HOMEOWNER
K & S Construction
CONTRACTOR
K &
S Construction
DATE 02-09-01
DRAWN
BY
Jaime Hawkins
NOTICE-
ry
c --ra
n y
-N'O...w-ar-ra=- ched
The -information shc)wn on the atta
Hed for use by the City Of
map(s) was compi
Edmonds/ its Emp[oyees and Consultants.
Th,.e City of *Edm.onds does - not ' warrant the
these
accuracy of anything set for.th on . *
r entity'requesting a
m2p(,s-). Any person c)
copy should conduct an independent
inquiry regarding the info'rm'ation shown'o
tFe -map(s),; including, but not Jimited to,
the location of any sewer stub shown. Suc
sewer stubs may or may- not exist and may
or may not exist at the location shown
nris nor its
�jty of Edmo
Neitheir tihe %.
empto,yee*s o,r office-rs -sh-a-1-1 be 1.-ia-b-'Fe for thE
n on this Map(5), nor for
infor . mation g've' Ided based
entation prov
any one repres
upon said map(S'.
i�
—P
JAN 22 '97 02:39PM
RECORDED
-.12
muftcTuLm2M20-4 DEED OF TRUOT
TM � OV "am (assounior ffUmb"s*4%6) An Race as
vaster to DJMWR W MY as, UPS
A� &ad =A X. MMM, RUMUM AM WZMZ
("verrowevo? . ft" trustee to aw ARPUMC fzm" go.
MR919400 COMPAMr.
which Is *regained 444 onlottev under taO laws Of fr= UP C=JCWA and whos;
address is 3750 43379 AV=Cff E.g. #S-j#S,, BML&Wya, ja 9#004
46handurej. narrower owes &eager %be priselpal gum of
so � Vim" MMW Amr � and X""---- Dollars 4'". 0 210#900.00
This debt If dvidSAC06 by Borrowers& note dated the me%* dtts as this Isoourity
tnatrmant INVoteel, which provides for monthly Payments, with the full debt, If not
Pals Earlier, due end payable :'tm AU=r 1�1:025_ - this Security Instrument secutes
to len"Ve W the repayment CAO 4240t 0 defted by the Pots, with integogt, sad all
raftewa2m, ffixt&REjons and oodigiestLeas 09 tbW ftts) 4b) the payment of all other tons,
with ifttsftst, advanced under p&r&oL-*rk 7 to protect tao ssogrity qg this 4quarIty,
tBsts'=800 and (0) the V8240ftonde of Morrowtvto covenants and agrooments ""ev %him
69curitY :nstruniont and the Note, For this purpose. norrawar irrevocably aftents and
convoys to Trustee, In trust# with Power 09 sale# the following described propert:r
&*sake& in MWORGMMEN County, WaNhingtont
Z47(8) 2, ACNZJt"%? VZZW, AOCCMZM 7a 7= ftAr =mRwy xscmm zR
WMI 22 OF MO. VAM(8) 94, AWOJWN ap ==ftffSff COMT*
MOMAW.
MWATE Zff 2W COMM or 0XVIMMOX0 OWT OF WARNMOM.
which has the address of ap"o SMAD PLUS �r* mw� 441cett, easy),
Washington, Sadao (,Property A44raose),
clip code) WA. BT. M Mu 3040 Itto
WashilwUM - visitt' Family - 72=10 Maefftoddle XBG ONZYM mmm? Pago I of 4
VOL. 3058PA0905
-P
RECORDEDI
NOTIC2 OF TRUST28#8 SAZA
File for it"Ord at Request of This bace Provided fig . Me
P" r. 20:
Professional rovoclogurc PACOrder 0 Me
Corporation at waehtngtq iAs"
sai sm. rifth Avenue, R25
Portland, OR .97304
(503) 241-0772
F PVC NO-196-6432
DL%'% -Title Order go. 1 383032
Tol
Dennis W. Smog lAsalle National Bank
19220 03rd Place w 13S a. LaSalle St,
Edmonds, WA 9402o ftoo 200
Ila K. Barnes ChL6690t 21 60003
19220 93rd Place N Peter X. Arkinon, Xg
admonds, WA 98020 103 B. Holly Street 502
Occupant Bellingham, "A 90225
29220 93rd place W Wa;hAington Natural an@ Company
to Zdmondap NA 90020 a% Mercer streat
Seattle, WA 9siog
KOTICE :F HUREVY GIVEN that the Uftd8r9ign44 Trustee Will an March'
28, 1997, at the hour of Joloo 6001ock A.M# at the main outran
P64 the Snohomish Coun5y Courthouse cc of
of Washington, sell at publle in the city of Everett. WA, State
bidder, payable at time ol s auction to the highest and beet
Els, the following described real
frqmrtY, Gituated in the County of Gnehomishp State of X&ghington,
O-Wits
Z4T 3 AMIRALTY VIEW, ACCORDING To THE pLAT THEREOF RECORMW
IN VOLUPM 22 OF PIATS, PAGE 64, RSCORDS OF SNOHOMISH COMM.
WASNINGTON. SITUATE IN THE COUNTy OF gNogONISH' STATE OF
WASHINGTON.
Commonly known'ai. 19220 N 93rd Place, admands, VA pg020
which is the subject of that certain Dead of Trust dated J ly 2s,
1995, recorded August 9. 3.095p undez Auditor's File No. ggog'090087,
records of Snohomish cou ty, Washington, from Dennis W. Barnes and
118 K. Barnes, humband :nd wife an Granter, to OLD 1413PubLtc * as
Trustee, to secure an obligation in War of Sierra Pacific
Mortgage company, Ine, as Beneficiary, the beneficial interest in
which woo assigned to The Bank Of Now York, an Trustee under the
Pooling and servicing 09CCOment dated am of September, 199S, among
*T1 r I (%
10L. 3247FAUE0533
22 '97 02;36PM
9
CWHBS* Inc., as depositor,
known as Independent Natio comtr"ift mortgage conduit, Inc. (now
"I Mortgage corporation) as seller and
master servicer, and The Bank oE Now Y*rk, as Trustee, relating to
mortgage Pass -through certificates series 1909-0, under an
Assignment recorded under Auditor,s pile No. 990-93.50140.
X16
NO action commenced by the Beneficiary of the 09md Of Trust or the
Beneficiary*s successor Is now pending to seek notime&ctign of the
Obligation in any Court by reason of the Grantor's default on the
Obligation secured by the Deed of Trust.
The Default (a) for which this fcr*clORur* 10 made in/41re as
f ollows:
pallure to FaY when due the following Amounts which are now In
arrearst
Monthly payments in the BUM Of $2,417.15 from Fobrunzy %, :L9.96
together with all fees, Costs and Or disbursements incurred or
P&id by the beneficiary and or trustee their employees,
Agents Or 88619no - The Trustee 0 a fees and,
at $1,900-00 &D of March 20* 1997. costa are estimated
IV.
The sum owing on the obligation secured b
prinei y the Deed of Trust jug
pal Balance 0249,913.C6, together with interest in the note
or other inutrLwant 00cur64 from February a, 1996, and such other
costa and fees as are due under the Note or other instrument
secured, Rr4 as.are provided by statute.
V.
The above- described real property will be sola to satisfy the
expense of Bale and the obligation secured by the Deed of Trust as
provided by statute. The male will be made without warranty
express or implied regarding title, Possession. or aneumbrances on
M6r0h 2a, 1907. The default(s) referred to in paragraph Ili,
together with any subsequent payments, late charges, advane 2,
costs and foes thereafter due, must be cured by march 17, 1907 ej;L
days before sale), to cause a discontinuance cE
the $ale. The sale
will be discontinued and terminate4 if At AnY time on or before
March 17, 1997 (11 days before the sale). the default(a) as got
forth in paragraph lij, r-09ether with any subsequent payments, late
charges, advances, costa and fees thereafter clue, is/are cured and
the Trustews fees And costa are paid. The $Ale may be terminated
any time after March 17, 1997 (11 days h6fOrs the Dole), and before
the sale by the Grantor or the Grantor,@ Successor in interest or
the holder of any recorded junior lien or encumbrance paying the
entire principal and interest secured. by the Deed of Trust, plus
1412200473 VOL. 3247FICE0534
1 77. - -.7
JAN 22 '97 02:37PM
'41
Mats, f sea and advaness, it Any# made pursuant to the te=0 of the
Obligation and/or Deed of Trust.
Vt.
A written notice og default wag transmitted by the Beneficiary or
TrUStee to the Grantor or the
the following addresgi ftuntcr*g successor In interest at
Dennis W. Barnes
19220 93rd Place
24mands, WA 9so2o
Ila X. Barnes
19220 93rd Place W
Edmonft, WA 90020
Occupant
19220 93W Place W
Edmonds, wa 98020
by both first ciase and certified mail Oft September 11, 1996 Proof
of which is in the possession of the Trustee, and the Grantor or
the ar"to" Rucaess" In Lnte;'elgt was Personally served oft
September 24, 1596 with said written notice of defau:Lt or the
written notice of default was rooted In a c0n4Pi*uQu8 Place an the
re:!,propertr described in paragraph I above, and the Truotee has
PC union or proof of much service or pogting.
VZZ0
The Trustee whose name and address areb not forth above,'and whose
telephone number to (503) 241-0772, will provide in writing to
anyone requesting it, a statement of all costs and fees due at any
time prior to the sale.
VIM
The ef f ect of the "16 will be to deprive the Grantor and all those
who hold by, through or under the Grantor of all their interest Ln
the above-destribed property.
Ix.
AnYOns having an objection to the sale on AnY grounds whatsoever
will be afforded an opportunity to be heard as to tho"'objections
if they bring a lawsuit to restrain the sale pursuant to ItcIf
61.24.130. Failure to bring such a lawau4t may result In a waiver
of any proper grounds for invalidating the TrusteePo gale.
f) 0 4 73
Voil. 3247pioEO535
�'N'
I
22 197 02:37PM
I .,., i . .10
PAIR MT COLLECTX'CM VR&MZCU ACT WMCH. Professional
Foreclosure Corporation of Washington in attempting to collect a
debt and any information obtained will be used for that punwee.
DATUD this /fRL day ofo�
PROPEES12ONAL FORECLOSM CoRpMTZUN OF
WASHINMN
B -A
y 2-d I jo ft h
rd U. 4 th
Vics-P
Vice-Presid nt/Asst. Secret&r-i
(303) 241-0772
PVC #1 96-60132
Loan Is 8730095
STATE OF OREGON
COUM OF MMTNONM
4M this day of I&R—, before me, the
undersigned, a Notary Public in and gar the state of Oregon, duly
COMMiesioned and suorng personally APPearod Richard H. ftith to me
knO" rO be the ViCe-Presideilt/Agpigtant geer*tary of the
corporation that executed the foregoing instrument, a
,nd
60knOWledged the aeld 1natrument to be the free and voluntary act
and dead of said c9ppargtion, for the uGeff and Purposes therein
mentionpd, and on oath stated that he is authorized to execute the
::aid instrument and that the seal affixed is the corporate meal of
id corporation.
Witness my hand and of flee @$&I hereto f f ixed the d y and year
first above written.
A- D'A
A2WL
fr1l' and4ar thb state
of Oregon
MY Commission Expirem:10
VV WCM ism 1XP*11 #A
1 0 =:�j
.9612200473
vot. 3247pwow
PUBLIC 'WORKS DEPARDMATBEET
FILE - 0
BUIMING PERMIT REVIEW
(date)
�0
Street Right -of -Way Exist
REQD
Z
.
I
Access Easements Existing,
REQD
H
p4
Utility Easement Exist*
Ing ------
REQD
Lot Per Subdivision — Plat>e-
--S A ssessor Map_
Site Plan Checked for Accuracy.
Z
Underground Wiring Reqd.
F4
0
Check Accuracy of Legal Description
Z
Review by
Date
W
I
Existing Water Main Size
-
Water Main Required
Service Line Required
Hydrant Size Existing
P4
Hydrant Reqd Per Fire Code
o �
:Reqd.
-Size
Detector Check Meter
Cross Connection Inspection
E-4
Fire Department Comnents
Water Meter Charge Reqd.
Review by.
Date
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
Pro].
DrM,7ing No.
File No.
Side Sewer Availability ---
Sanitary Sewer Connection Fee qd.
�3:
Review by
Date
Open Ditch Existing_
—j�eqd.
Culvert Reqd.
Size
P4
Catch Basin Reqd.
Indicate on Site Plan
0
Shoulder drainage maintain collection
on swale open runoff
P
Manhole reqd.
Indicate on Site Plan
Soil Conditions and Ground Water Field
Checked
Review by
Date
Revised: 1vl0-1977
Page 2
Street Paving Reqd.
Curb and Gutter Reqd.
Sidewalk Reqd.
Curb Cut for Driveway Reqd.
r4 Right -of -Way Construction Permit Reqd.
Bond Reqd. for Public Inprovements
Street Nam Sign Reqd.
M
Other Signing Reqd.
Pre Permit Site Inspection made on
0
BY: SEWER
WATER
Pq
STREET
�X4 ENGINEERING
*0
Special Requirements listed in mew to ComTunity Development Department,
Building Division
BY Date
o All items filled in on Building Permit Application
BY Date
Drawings Stanped and Notations Made
BY Date
Approved by Public Works Department
Revised: lv 10-1977
APPLICATION
FILE
The City of Edmonds
STREET
for
SIDE SEWER PERMIT
EASEMENT No . ..........................................
NF�W CONS U TION REPAIRS
OWNER .... ........... ....... . .........................
------- ----------------------------------------
CONTRACTOR .............................. ............. ............ ..................................
PERMIT No. .....................
ADDRESS... Z� ....... ....................................................
.................................
LEGAL DESCRIPTION: LOT No . ...............................
............. BLOCK No... ............ ........ ....................
NAMEOF ADDITION ...............................................................
—Z
......................... ..........................................
X"
......... .......
A P P,!-,,,� c-'. ��; _ j
NOV
Approved:
DATE ..... / ... / ........... .............................. B,
.1 ........................... ----------
CITY OF EDMONDS Call PRospect 6-1107 when work
qXV.XC, CENTER — WATER-SEVVER DEPARTMENT is ready for inspection. (No inspec- IXTO -13
I - 95
tions Saturday, Sunday or holidays.) X I
SIDE SEWER PERMIT
ADDRESS ----------- 19220 .... .... 9-3-rd --- P.1a.ce --- W-eat ---------- ------------------------------------ . ............................................................. ----------
---- -- -- -- - - -- ----- -- - ----- -- ---- --
OWNER ............... Robert --- Ar-i-de .......... ------------------------------------- coNmAcToR --------- Olympi-c--Nie-w .......................................
---- ---------- -- -- -- ----
Permission is granted .. _..N.q.ye_m_beT, ... 3. .... wer
.... .. .. .... _... I . ...... ... 19.!�T, for --------- .... days to REPAIR or CONNECT a side se
with City Sewers in accordance with application On file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer iii street area. Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NC 'To. 3—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%.
No bends in grade sharper than % will be permitted.
NOTE'No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
NOTE No. 5—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its appur-
tenances except to insert the pipe into the wye.
NOTICE,
r
Tt a. C. c-9.
'0 ... w.'a'r.r a nty-
N
The information shown on the attached
Hed for use by the City Of
map(s) was com ' p
Edmonds/ its Empl.oyees and Consultants.
Th,..e City ofEdm.onds does not . warrant the
accuracy of anything set for,th on t ' hese
M a p (S"). 'A n . y person or entity'requesting a
copy should conduct an -independent
i orm'ation shown-o
inquiry regarding the 'nf'
-t-Fe -rn a p (s) / including, but not i'mited to,
the location of any sewer stub shown. Suc
-not exist and may
sewer stubs may or may
-t at the location shown
or may not exis
Neitheir the City of Edmonris nor its
14 --/
e M p. o,y e e's o'r 0 ff i -c er s 's h. b e Vi a. b.-'Fe f o r h
on this map(5), nor for
infor mation g'Ve' ion provided based
3ny one representat
upon said map(s'),
STREET FILE
SNOHOMISH HEALTH DISTRICT
DIVISION OF SANITATION
3011 Rockefeller Avenue, Everett, Washington
APPLICATION FOR A SEWAGE DISPOSAL SYSTEM PERMIT
(Submit 3 Copies)
Permit to be issued to: ................. A9�1.t42 ........ ........................................ ------------------------------------------
C2 'eA:� "q�
For installation at: (street address) ............ ........ ........................................................................
Addition or Subdivision --- -------- ................................. Block. --_----------
Type of Building: New-,4/ ..... Existing ............ Single family residence,./4/je .. Number of bedrooms....---,?
..................
Other: (specify type or use) -------------------------------------------------------------------------- ------------------------------------------------------------------------------
Builder ...... z�."/
Designer-A-7;M/ ...... Address;� ...................
---------------------- ..... .......
............... ..
Soil Log Hole No. I ...............
--------------- --
y ....... .... ............ ...... _ -------------------_--------
..............................................
Soil Log Hole No. 2 ......... _0.:7 ---------- _-41 ...........
------------------ .......... -----------------------------------------------------------------------------
Elevation of Water Table, if encountered. (Distance from ground surface) ..... 4�1_vler
.................................................................
Corrections to control surface water if needed ----- ......
.................................................................................................................. .............. ................. .................... ........................
Specify if any removing or grading of topsoil in field area ---------
r ------- ..................................
Percolation: e
Test Hole No. I —Average Rate .... /I ........... .... (Fall in minutes/inch-bottom 6" test hole)
Test Hole No. 2—Average Rate_ .4__Ii� - A^ ------ ...................... I ........ -(Fall in rninutes/inch-bottom 6" test hole)
Test Hole No. 3—Average Rate ... 21-5
-- -------------------------- ............ ..... (Fall in minutes/inch-bottom 6" test hole)
Average percolation rate on which to base drain field design ..... ..................... 11 ........................
Septic tank requirements based on present rules and regulations:
Septic Tank Size ...... �.V4� ...... .... gallons.
Amount of Square Feet of Disposal Field --- :ni�� ------- _---_-
-- -- ------- .................... Date ----- . ...........
Signature — Designer- - --- --------------
DO NOT WRITE B OW THIS LINE (To be completed by Issuing Apncy)
Permit issued (date ... ... /_g ;%,?
, /./gi .0 .............. Permit Number ... /..33) ...
Remarks: .............. .... ...........
PROWN
54'
A
t-�:-
1 Q6
-3o
�2-72
ol
AA tJ, F: L p
N
9w
W4L<
L
Z76
NZ
-35,
98
ROAD
ARCA
VIE ul,
RL C) T PL 144
LWA lk�clzlZ& A
W4 5
,/Vo
i=T. OF
2-91,
AR -&A iti Z. iv/,.>E c 6>, 1-.
-4 - 6- cz� :30"
L,4T��AL�5 AS SHO(,,-)tj.
'SYSTEM To ftF- IN Ac-c-0lZ0AeJc,6 IVI TM
3
COIJIJTY P-�Jl-E5 W:-Z(4JLAT-
m
RtE�q A TZ U IAJ 7 -(C-
o VC14
A-r A
no,
[C;9MM�0NDS.
2) - 4o SA. Lo.
7301 - 1�
7301 - 179th S. w.
WASHINGTON PR 6.tSW
40 - -fe' TIL'It4j- -5A -
PERCOLATI TEST
PLOT PLANS
/4,;/,'A) SA, 4� 0
FLAV 924LOPMENT COORDINATOR
OR
T141#7' 54, Clie-
647 —3
CITY OF EDMONDS
DEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, Edmonds, Washington
SEPTIC TANK INSTALLATION PLAN
(Submit in Triplicate)
19220 — 93rd P1. W. Snohomish County
ADDRESS OF PROPERTY ................ .......... .................................... ........................... Lot No ........... 3 ......... Permit No ..... -13930....
Owner...... ..... .................... ............ ................... Address .... .............................. .......................... Phone ........................
Builder - _-Rud Thees
......... : .... ........ I -------- ........ . ............. . Address ---- .-6211.-N...E..--153rd,...Kemor.e ..... Phone ........................
Designer ----- Ron.. W.hal.ey --- As-so.c.ia.tes ...... Address ----- 73.01..—.179th ... da Phonelr....6,5$80
Installer ----- Northlake Concrete
. ....... ......... - ......... ...... . ...... I ... Address ..... �RQV!011 .............................................. Phone.H.U& ... 6!--3191
1 hereby certify the accompanying drawing is an aCCLIFatC 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 ................
. ...... 6/17/63 ....................... have been complied with.
... .. . . ............... ........................ $1,12/63 ---------
Signature of D�esigner Date
TO BE FILLED IN BY CITY ENGINEER ONLY
Accepted ...... ........ ............. - --------- -- Date .. .... I .. ....
Not Accepted ... . ... Date ...... __ I .... 1 ....
Signature of Sanitarian ........ ................................
.. . ............. ... ...........
Remarks: .................. .............. .... ................. ............ .......... ....................................................................................................
................... ..................... ..................................... ........................ ................................................ I .......................................
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 (2y2-3 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 harin the action of the septic tank and
disposal field.