HomeMy WebLinkAboutSWG Application / As-Built ^' - P.O. Box 746
Shelton, cm. 98584 THURSTON-MASON HEALTH DISTRICT
PF one: 42"407 p"SpW or SAL S1XALTM 4th S Brenner
Olpmpa�.WA. 98501
'OWICER�' Phone: 753-8073
a - PH02IE��G
ObRCER"S ADDRESS L 9 CITY
SP1v REPORT 10
STATE
SEWAGE CORMCPOR I
ADDRESS
y�(�7lf�fself confer with �/cI 1
LEGAL DESCRIPTI@i ^ i tZ•/ 9 1
MA
PARCIM NO. 9 I.or SIZE 70 ^ 290 nrrM2D8a USE OF BL)G.
No- OF BEURDU'+LS--;9�_ NO. OF BMWWOM /L� �BAS&IMM PLUMBI2.G: Yes I NO
"KE OP '0T Sys"21 � 7f�-
�"`---�---"=-> ItIDIVIWAL PUBLIC
I 'q'S TO p PERTy: (Be Specific) / �I��
DRAW A SKETCH SHOWING: 1. Property lines, location of house on the lot, mad
lot. 2. Location of the house and sew d'^^nGions of the
soil log holes, patio, driveways, � disposal system in relation to strew, lakes, wells,
vewap underground tanks, water supply lines mad easements.
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o
The se tic system is an approved te=poraxy method of
DO NOT WRITE IN THIS SPACE sewage disposal
MMIRUKS:
Septic Tank a
Drainfield
SITE APPLICATIOl
/ APPLICANT'S SI(2(AZ'URE s.�, ,(L?:
SITE IHSPECPION PEE o R 3// �+� D 'Etfi i .Z,2—7S
/O ECYIPT tto,
APPROVED/ LZ -Zst iwr APPROVED
Date _
DateEy
Date
InsPe .S.
SSWA( 3 APPLICATION / ?MW / ALTERATION
APPLICA?rr.S SIG2iATURE
PEE ' DATE
S C�� RECQIpf No. 2.3// Bx �
PER2Q1' 2J0. O APPIZpVE , / Q 7 M - I _ J
Da CPit f.
i ec /E.H.S..
SROGE S!SIUi Cj-:7jTFITCAiIONi
?rope t:• Owner 42 -- �2 L�,aid�AddresOf
s
Sewage Contractor Date g parcel=
1 . scale. 1 'cuaire = 101
2. Draw in PbyslLval structures to be on lot.
j. Show location of well or any body of water.
�• Show location oI' septic system in relationship to structure.
5• Assumee an elevation of 100' at one lot corner do indicate the other lot corner
elevations in relation to it.
6. use Arrows to show direction of slope.
too,
i
"r-15o�
40 PL.-
_ J
V
Septic Tank Volume 140 O
Drainfield Length �S
Cubic Yards gravel used L,7-
I certify that this system is installed as shown above, and that 11-
requirements and standards of Thum4ason Health District have
been satisfied.
Signature
Contractor License
Sune, 1970