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19241 94TH PL Wiiiiiiiiiiiiii 15527 19241 94TH PL W STREET FIL.E.. OF EDMONDS DEPARTMENT OF PUBLIC WORKS 250 Fifth Avenue North, Edmonds, Washington SEPTIC TANK INSTALLATION PLAN (Submit in Triplicate) -J- 97/!;?n�?�! ADDRESS OF PROPERTY ... ............. �.O ..Z ..... VJ .... CV-4-0 t . ....... Permit No.. Owner_ ... ... . ................................. ........ a - ..........Address .... .................. ----------- __ .................. -- Phone ......... __ ........... Builder -Aet ..... Address.. 1f%5-944_ _'-Foe. �P7 ... 41(l ...... .................... ... Phone ........................ '4- ........ ­ Address-- J-.3�s—O.sw. -.4PY7. .........1LI....................... Phone ........................ Installer__. 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. ............ I ........... ::; ;; �4& ". .................... Signature of L6eriMr Date TO BE FILLED IN BY CITY ENGINEER ONLY Accepted........ Date. Not Accepted .................... ....................... te...) .... ...... --------- 6,17/ Signature of Sanitaiian .......... . .. .. .................................. Remarks: ...... et�Z_ ............ .. .... %-,d ....... .. 44-el ....... Mot- -4 ......... .......................... 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 (2V2-3 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. a1dE�t EirE 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: ----- WAIJAM ........ C--. - TA_ f C I... ... Te '�-Oy?v ......... 1,9 .2 el For installation at: (street address)-.. ------ 74791 .. ........ ............... ............ ...............................•........ I Z3 1 Addition or Subdivision ... Aa./q1AzA7—_1_ ----- Vt4 -j - -------- I .....----- ------.-------- .. Lot4;I/Block_ .............. Type of Building: New ---- Existing --- �/ ------- Single family residence....... Number of bedrooms............... ............. Other: (specify type or use)---` ---------------------- ------- ..................... ­­ ......--- .---.......................... ........................................ .._..Address..--- .................................. Designer ... W, -------- Address._JT74�_ "_t M.4.1J. ... . Soil Log Hole No. 1 ---- -------- SA W-. -,V ... * -- ----$7 ­......... --------------------------- ­ ---------------------------------------------- ------ ­­ ------- ........... .. ­ ................................ 1 .......... ­­ ........ ­­ ...... ........................ Soil Log Hole No. 2 ----- --------- mo ..... I ----- 0, ,fA yc. ..... ..... ............. ------------- ....... ------ ................................................................. ------------ .............. ................................. ....................... .......... Elevation of Water Table, if encountered. (Distance from ground surface) ...... ) \/'V —rd'k'. .._ .. Corrections to control surface water if needed--------------------------------•--------------•--•-------•------------................---.................----........ .................. .................................................................. ................... ­­­ ......... .............................. I .......................... t ....... .............. Specify if any removing or grading of topsoil in field area ....... A/0 ..... .............. . .... .................................................. ......................................................................................................................... Percolation: p e. Test Hole No. I —Average Rate ....... .... 14 Test Hole No. 2 —Average Rate .... PAC ------ Test Hole No. 3—Average Rate._/--P� PA'C---*0'V Average percolation rate on which to base drain field design Septic tank requirements based on present rules and regulations: j AM^ (Fall in' minutes/inch-bottom 6" test hole) ---- (Fall in minutes/inch-bottom 6" test hole) in minutes/inch-bottom 6" test hole)) I e* b - =A/ ...... .. ­ ... ....... ...... Date Taken ----------- --- ------- 6eptic lank Size .... ......................gallons. 'Ago - Amount of Square Feet of Disposal Field... Signature — Designer. - ------ ...... -------------- Date.----. ......--..�1...5 DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency) Permit issued (date) ........... .. ..dam ............... Pei'mit Number ------------.......................... Remarks: ......... .......................................................................................................... .......... .................... . ................................... V" J�1G i=�.vso -poi y 7 jo TP�T� co Me w i� fl ' 7 is B.1 T, 2 vel /poo 61���%iG 7WjVlc,�' 3sa 5y NOT(C�: N'O..W a r -r a ncy The in shown on the attached . for use by-�heCityQ1 map(s) was Edmonds,'ts � � cornpiled - Erg l-o ees and Consultants. onds does not �ar�ant the -. Th.:e City of Edrn. . accuracy of anything set forth on these . rnap(s). A n y person or entity -requesting a could conduct an independent copy �� inquiry regarding . the infbrmation. n showc � � tHe map(s)/ including, but not limited to, an n of sewer stub shown. SU( the locatio y sewer stubs bs may or may not exist and mao or may not exist at the location shown. a . �-`�he, the City of Edmunds nor its Ne�� e m ._.1.0.. e e-s o-r Off ice,rs .s.h.a. . information given . n this �nap(s)) nor for o any one represent provided ation based . upon said map{s'a Septic Tank ......... /--:—c.s -...... gals. Disp. Field _--__-__--:w:'-?---- -sq. ft. SEWAGE DISPOSAL PERMIT CITY OF- EDMONDS Department of Public. Works No. -----A Other---------- ----------------------- ------------ % /.,:^ y - c� ----•- -*� •-•-�-5-•1•--------------------------- is hereby authorizes, �� ...��..., Name__________________________________!- '_._-____- repair sewage disposal system at 1 Date issued on----_----- - e � rs _G��.<:•----• = ».! 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 ---------------------------------- Approved .E] Disapproved'E] Date ---------------------------------------- -----------L By ------------- :------•-- --------------------------------------------------------------------------------------- --•---------- - ---- - •----•------------------•---•-------------- Date ------------ -.-------••---•--•--•---•---•--.-••-•--_----- SANITARIAN OR DESIGNER-----•----••----------•---••-•--• - - - - - This permit shall be posted in a- reasonably conspicuous place on, the job until inspection has been completed.