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Page I of 7 <br /> TITLE, INDEX AND PROJECT SHEET FOR POWTS PLAN SUBMITTAL <br /> Property Owners Name Property Location <br /> edam G. (y_)a_r,do r 516 tJ E z7 (n AI ( t 6 <br /> Property Owner's Address Project Address(if different from owner's) <br /> c2g11 S.Pe<<1cl1-xM br. .Spt-:ng Rc\, <br /> City& State Zip Code Phone# Subdivision Name or CSM Vol&Page <br /> S*t,�ir,�o n , vJ 1 53 S )q Lot# Block <br /> U City <br /> Type of Building <br /> '1 or 2 Family Dwelling-No of Bedrooms 3 ❑ Village <br /> 0 Public/Commercial- Specify Use- Township of I��scx��� i--`r;55 <br /> Filter Details <br /> Effluent Type '$t Effluent(Type&Model) L f$`-c-- CT l IqS, <br /> Number I (Septic) 0 Basin used(Manufacturer& Size) <br /> O Number 2(Highly Pre-treated) lnline(Type& Model) <br /> Fl High Strength <br /> Component Manual(s)Used(check all that apply) ❑ At Grade Using Pressure Dist Ver 2 SBD-10854- <br /> 3j Inground Soil Absorp.Ver 2.0 SBD-10705-P(N.01/01) P(N.03/07) <br /> O Pressure Distribution Ver.2.0 SBD-10706-P(N.01/01) 0 Mound Ver 2 SBD-10691-P(N.01/01) <br /> ❑ Small Scale Wast Management Project Publication 9.6 ❑ Holding Tank Ver 2 SBD-10855-P(N.3/07) <br /> INDEX 6 Other.-Explain �.):�.104 -Plcs Sl-cyNdo.rot ct►u Q`'S <br /> Page 1 TITLE. INDEX&PROJECT SHEET <br /> ATTACHMENTS(List) <br /> Page 2 ?146'V P`Qn <br /> Page 3 0,-):c,k I ‘us S}anc6rci GA\an6X <br /> Page 4 to e.a_ Co SO )3 Sb• `"`7' c.1-0,in\( <br /> Pages f `'A-e Y' A Q tikzet cW‘c.e <br /> TOTAL ATTACHMENTS <br /> Page 6 m cm(fit: e..rn-e_r\ - ?\aY,.. <br /> Seal of Designer,Architect or Engineer(If <br /> Page 7, \)S ex-- (Y.CI`n v A Applicable) <br /> Page 8 <br /> Page 9 <br /> Other pages: <br /> Total Pages This Plan <br /> I THE UNDERSIGNED,HEREBY CERTIFY THAT THE For Office use Only <br /> PLANS AND SPECIFICATIONS SUBMITTED HEREWITH <br /> WERE PREPARED UNDER MY DIRECTION AND <br /> CONTROL AND THE THE CONSTRUCTION AND <br /> INSTALLATION OF THIS POWTS WILL COMPLY WITH <br /> SPS 383.33 W.A.C.AND OTHER APPLICABLE <br /> REGULATIONS. <br /> Plumber .5'F-'NJ E.,n T .s''n,kr <br /> Credential# 7-2:111 t0 Date 8 1‘1v (I 1 W <br /> Signature <br /> 9/� c'L. <br />