HomeMy WebLinkAboutSWG Inactive - 3/20/1985 � 4
SITE INSPECTION CHECKLIST No.
Check every acceptable feature. Leave every questionable or unacceptable
feature blank. Explain every blank in the space for the remarks.
ITEM APPLICABLE REGULATIONS
1. Soil in holes-describe layers & depth Art. VI Sec 3.5(a) VII 3.3, 3.79
10.2
2. Existing sewage systems
474 3. Existing structures - check use Art. VI Sec 3.5 VII 4. 19, 4.2
4. Existing wells - check construction Art. VI Sec 2. 1(b) VII 4. 1
5. Presesnce of fill Art. VI Sec 1.8 VII 3.6
6. Has soil been removed? Art. VI Sec 2. 1(c) VII 4. 1
2.4, 3.5(f)
V/ 7. Salt water Art. VI Sec 2. 1(c)
8. Lake Art. VI Sec 2.1(c)
.1 9. River Art. VI Sec 2. 1(c)
-_,/40. Creek Art. VI Sec 2. 1(c)
11. Stream Art. VI Sec 2. 1(c)
12. Pond Art. VI Sec 2. 1(c)
•3. Swamp Art. VI Sec 2. 1(c)
4. Misc surface water Art. VI Sec 2. 1(c)
45. Property Art. VI Sec 3.5(f) VII 4. 1
-7-16. Banks or cuts Art. VI Sec 3.5 VII 4. 1, 3.7
17. Distance to public sewer Art. VI Sec 3.5(g),
9.2, 10.2,
10.3 & 10.4
ter,-18. Water table - Record depth Art. VI Sec 3.5(d) VII 1.4
119. Slopes Art. VI Sec 3.5(e) VII 3.7, 4. 1
�20. Driveways and roads VII 4.2
�,21. Drainage patterns Art. VI Sec 3.5(e) VII 4.1
Interceptor drains VII 3.8
,23. Culverts
2 4. Water lines VII 2.6, 4. 1
25. Flood control zones VII 4.4
Roof drains VII 3.2
27. Vegetation VII 3.2
REMARKS
DATE
BY �,.✓',. �
SEMIGE SYSTEM PERMIT APPLICATION No. Permit Expires
MASON- COUNTY HEALTH DEPARTMENT FOR DEPARTMENT USE ONLY,
ENVIRONMENTAL HEALTH SECTION DATE BASIS FOR FEE AMOUNT RECEIPT NO.
303 NORTH 4th STREET • SHELTON, WA 98584 r ,� l � ¢-Cy(} �f, ✓
PHONE (206) 426-5561 I tY:. W
APPLICANT SIGNATURE
1.EC r ii_Sca'
ADDRESS 7 PHONE
lli,fG ,S&/u1l A.'e,'TN Fit/ LiA 9 F-A4.S ,, SITE R�A roved ❑ Not
PROPERTY OWNER � 07"w pp Approved
ADDRESS _ PHONE BY. A
P" 'oeAaY ACCXA" i� `A r�'Fd1Sr ��J'-15i��/ DESI N SYSTEM REQUIRED
SEWAGE SEWAGE J�7
CONTRACTOR plc�I/lt b DESIGNER �Eh/C RZ�
LEGAL DESCRIPTION INSTALLATION: ❑ Approved ❑ Not Approved
LC? 0la !/ - RuiaeeR ,op. BY
L,t*-- t4A,P 1/i4 L-p d A' DEPTH TO WATER TABLE
TYPE OF NO. OF LOT -
BUILDING rA�%` BEDROOMS �j SIZE PC XL49 j
SOIL TYPE '
WATER SYSTEM SINGLE RESIDENCE
SYSEM 0 PUBLIC WAER
COMMERCIAL ONLY (,/
LIQUID WASTE G.P.D.
t.
DIRECTIONS TO SITE:
ek tier:I,, �i�'� �I bEPTIC TANKS) GAL. PUMP REQ.
AX O A 77- "t DISTRIBUTION TILE TOTAL FEET
FINAL INSPECTION REQUIRED BEFORE BACKFILLING
DEPTH
�. /
(f •'rr " L J-) 1I1e itay� ��BACKFILLLF
a r C ,7 Ni c , '✓`/ ' V r .V_J L/ 2"STRAW OR PAPER
ry ��_ f-�STONE
Illf/� 1%� Y r- ��'• q-orJ �2 OVER TILE
/� �� F PIPE SIZE
STONE
SITE PLAN AND SPEC IA STIPULATIONS UNDER TILE
(INDICATE DIRECTION OF DRAINAGE) CROSS SECTION OF TRENCH
C
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