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19221 93RD PL Wiiiiiiii iiiiii15504 19221 93RD PL W STREET FILE10 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: ..................... ...... 47--e -,6,0 ---_------- For installation at: (street address).__ ._____2 --- lam__=.___....�-3 �___ L•--------- Addition or Subdivision._14.TY ....%l.=lt_________________ Lot ---- 7------- Block ---------------- f� Type of Building: New ---- X..._ Existing ------------ Single family residence_.�Ps---- Number of bedrooms.... �................ Other: (specify type or use) ------------------------•---------------------------------------•--------------------------------------.._..--------------------------------------------- Builder �iqL i ----C/G,cr�__0------------------------------- Address_,,/Zs5 --- -- 9 'e------- --�r--/--�AS/� �l ___._____. w Designer•/ L�/...�C !SSOC ' Address%3Q/-17y t'rS. 4!/ir�o� Soil Log Hole No. 1 ------ e- .ooSE.../y%Pr c 1---- .--- -.�-----`-`-/�).......... --•--•�g: p ."..4-eaSE.._- . . . . . . .. 13..----XC...... i-'r -l_'. J.f .'-'/- •7_.6 r--. Q/7C/-------------•--------------------------•----- Soil Log Hole No. 2------ �~ �•� ��'� yin '�%�3,e�✓ .._, 4 1C1lcr --------------------- Q.aa- .-�3 ,c(------5----------------------------------------------------------------------------...... Elevation of Water Table, if encountered. (Distance from ground surface) ...../vo............................................. Corrections to control surface water if needed --- .--.-_._/Y�tA/-.__------------------------------------------------------------------------------------------ Specify if any removing or grading of topsoil in field area ----------------------------------------------------------------------------------------------------- .................... Percolation: Test Hole No. 1 =Average Rate ---- 2' d........................................(Fall in minutes/inch-bottom 6" test hole) Test Hole No. 2 —Average Rate ---- /% -4-0 ----------------------------------------- (Fall in minutes/inch-bottom 6" test hole) Test Hole No. 3 —Average Rate..4.3............................................ (Fall in minutes/inch-bottom 6" test hole) Average percolation rate on which to base drain field design.-__ ................. Septic tank requirements based on present rules and regulations: Septic Tank Size --- ?��-------------gallons. Amount of Square Feet of Disposal Field... jo0 __ . Signature —Designer ------------- ----------- Date..... ��/.--..._------ DO NOT WRITE BE W THIS LINE (To be completed by Issuing Age cy) �� / Permit issued (date) f_____Permit Number-._._.-. -------- ---------- Remarks: ................. ------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------•-------------------•-------•-----•--•-----•-------------•---------•----.........--------------------------------------------------------------...----------------------------------- OROWR L©T�oii 4, 3 O�'S/rN •� � 3 D 7301 - 179th S. W. EDVONDS, WASHINGTON PR 6-5880 PERCOLATIOU TEST Pi..o'i 41cAIPGS PLAT nFvF(,a >5. ,V 4TMRDINATCA r/aB 0,lG / `3 j ro/A 618 - 7 • i SNOHOMISH HEALTH DISTRICT DIVISION OF SANITATION 3011 Rockefeller Avenue, Everett, Washington SEPTIC TANK INSTALLATION PLAN (Submit in Triplicate) Snohomish County ADDRESS OF PROPERTY 19221 - 93rd Place West Permit No. 13899 Owner----------------------------------------------------------------------- Address------------.------------------------------------------------------ Phone ------------------------ Builder-- _4#_R4lPk._Q ,.b-o------------------------------- Address ....... ].].5.0-.Korth...93rd.-i.-.Seatt.le. Phone --- LA.--3ntll�3 Designer...Ron Whaley & Associates _ Address..--.._7301 - 179th S.W.,-- Edmonds phone-- p.I�.�.. 6:nW ....... . .... Installer-_--- B gc M C011tTaCtOI 5..................... Address ---------- PA ... 0.....&M.-1-0.5...SeattleJitMione--- FR*... 8-Q247 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 ................ -----------------611z 63.............. have been complied with. .-.....- -....................... ......................... /..19./63------------ Signature of Designer Date TO BE FILLED IN BY HEALTH DEPARTMENT ONLY Accepted ------- ------------------------------------- Date.---1 NotAccepted------ -----•-------•------------------------------- Date------------------------------------- .. Signature of 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 (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 liarin the action of the septic tank and disposal field. BROWN a CA IAI r?�V4� woll w4alex 7301-179th S. W. EDMONDS, WASHINGTON PR 6-sw MM7710K TEST KA46 PIAT nFK(.f,*WV f4MDMAYM "47,e Ate I All"