HomeMy WebLinkAboutSEP1970-00004Eases t Caroline OLYMPIC HE)',"I I�IST£ICT Permit No.
Port Angeles Fee Paid
SEWAGE DISPOSAL 'P.MkIT APPLICATION. aq(oa W
Submit in Du lig to I7�T . 53711
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NAME7- CADDRESS = D DATE
LEGAL 'DESCRIPTION/'.�. /.?/ /1a $ON
DIRECTIONS FOR LOCATING SITE&9f
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APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM Y'PAIR EXIST=G SYSTEM
PERCOLATION TEST RESULTS
Depth Time required tb ercolation rate Type of soil
of holes last 6 in. ( ' ` ide time by 6)
Pero. No. V le
FerC • NO • 2 —�"� sr i�
Pero. Not
AL
URATNFIELD LENGTH WIDT .2 DEPTH ..a NO. OF LINES - =a
j�
rMurVOLD INS'TALLA.TION WILL BE DE IN THE MADINER
AS DESIGNED AND APPROVED ON THIS APPLICATION,
<
APPROX. DATE OF INSTALLATION /0, %` 1V�Ae Applicant
SANITARIANS COMMENTS: ~
THIS CONSTITUTES P yrHEN HEALTH OFFICERS SIGNATURE APPEARS AS APPROVED
I�
PLAN APPROVED DISAPPROVED DATE
DATE INSPECTED
- m'Z7 i OD , SANITARIAN ` o
IQ)
RE14ARKS :.3- 1-7a,
.. o
5-68
U1
A V BCPs 'S/
'YPE OF BUILDING NO* OF BEDROOMS BASEMENT SITE ST2Z NAME OF INSTALLER
4N
THE REVERSE SIDE, .DRAW A DETAILED
PLOT
PLAN GIVING THE FOLLOWING INFORMATIOT
1.
Z,
Property lines
Location
7.
Driveways, patiost carports etc.
3.
of building
Location
8.
.Streams or bodies of water nearby
4.
of septic tank
Location of drainfield
9•
10.
Location of percolation test holes
Septic tank size ey 0 ,galloar,
5.
E.
Slope of land
dater lines & well(if
1l.
""""" _ °""'.'
Length of proposed drain.field
applicable) 12.
Depth,to water if encountered.
PERCOLATION TEST RESULTS
Depth Time required tb ercolation rate Type of soil
of holes last 6 in. ( ' ` ide time by 6)
Pero. No. V le
FerC • NO • 2 —�"� sr i�
Pero. Not
AL
URATNFIELD LENGTH WIDT .2 DEPTH ..a NO. OF LINES - =a
j�
rMurVOLD INS'TALLA.TION WILL BE DE IN THE MADINER
AS DESIGNED AND APPROVED ON THIS APPLICATION,
<
APPROX. DATE OF INSTALLATION /0, %` 1V�Ae Applicant
SANITARIANS COMMENTS: ~
THIS CONSTITUTES P yrHEN HEALTH OFFICERS SIGNATURE APPEARS AS APPROVED
I�
PLAN APPROVED DISAPPROVED DATE
DATE INSPECTED
- m'Z7 i OD , SANITARIAN ` o
IQ)
RE14ARKS :.3- 1-7a,
.. o
5-68
U1
® ON-SITE SEWAGE DISPOSAL SURVEY OF
A
�0
Location, Lot Size
II. System Owner
Address
X Telephone Number
Permit (?) (Previous Owner)
Date Issued
Street Or
ft, ..;e;.,., R1 r,,-1, 1 nt 1 andmark ( nt 5722
III. Installer L_
Date Installed 1cm
A Time In -Service (years)
Septic Tank Pumped
YES NO HOW
OFTEN
# of Months/Years Residence Occupied?:
x Average Number of People Served
Number of Bedrooms �-
Clothes Washer
YES NO
K Dishwasher P__111
_ YES NO
X Garbage Disposal
YES- NO
IV, Type of cover over drainfield. (i.e. grass, landscaping, etc.)
V. Repairs (when, what, who) Cause of Failure
VI. ��Comments (Over for Sketch) `
VII. Action Taken'
i
® ON-SITE Si;W1kGE DISPOSAL SURVEY OF
IQ
\ , N v
Co. q
Location, Lot Size
X
II.
X,
System Owner
Address
Telephone Number
Permit (?) (Previous Owner)
Date Issued
Street Or
Pino- L 1 nt I andmark I nt Si7P_
39S-1793
��snoA
la �7a
III. InstallerL�Icl
x Average Number of People Served �-
Date Installed i7 Number of Bedrooms �-
A Time In -Service (years) X Clothes Washer
X Septic Tank Pumped
YES NO HOW X Dishwasher
_ OFTEN
# of Months/Years Residence Occupied? X Garbage Disposal
IV, Type of cover over drainfield. (i.e. grass, landscaping, etc.)
V. Repairs (when, what, who) Cause of Failure
_ t
Y -
ES NO
YESNO
- --
YES- NO
VII. Action Takers
-k-