HomeMy WebLinkAboutSEP2004-00047 j\o0n-abs- L,r,-, �.� L., PtP 935 4odo t 9,CONVENTIOtN"ALE SYSTEM ASBUILT INSPECTION REPORT
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INSTALLER (7-3) ic�,v�� C OAS frGcc: icti` PARCEL # (/-V - c)' 2
Permit Owner /�Jc cl-tiu /) �C%Ir'((3 Permit # :-).:6"..) fix - ("70(1(/17
ABSORPTION AREA:
DRAINFIELD TRENCH -, / TRENCH -) // TANK #OF #GAL
LENGTH /C\U WIDTH DEPTH c C" SIZE /C�D BEDRMS ,3 DAY ,S�C}
Tank Shroud/ , ,
IF PUMP AND PUMP CHAMBER REQUIRED: Size /t///-- Screen Wil
Float Arrangement �0} �' ,.
High water float-distance to top of ank/emergency storage ,J/, ✓ �- ,�,
Dose drawdown (#of inches) -2/ �� ��
f # Gallons/Dose .A-'.) ,' ,,,),€,,
Timer/Dose Counter info ,idl Pump Size/ Manufacturer /e- 1
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I CERTIFY SEWA .ONSITE TEM AS INSTALLED AS DESIGNED, PER PLAN APPROVED 3-i2-1?
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INSTALLER SIGNATURE / DATE INSTALLED
1(49 n t.n b t b1 ta"›5,44.7.4)t37 PkLa L j GA—Anzix4m2.) t r
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-1444 — 2fr�
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EXPIRES 121 2/,
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\ 30 7-c.) gig Skid!T. \ • g
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plan submitted by4. r.l 1 I )LM� ih
0- ENVIROV6HECK, L.L.C.
1612 Hastings Ave. W. as a pa •f a Monitorin insp- tion
Port Townsend, WA 98368
Not reviewed o -•proved by JCP k
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