HomeMy WebLinkAboutSWG97-0853 - SWG Inactive - 12/30/1997 _a
MASON COUNTY DEPARTMENT OF HEALTH SERVICES
PERMIT NO. SWG' — D m
C N
Date ��-3t7 R7 N o
426 W. CEDAR/ P.O. BOX 1666/SHELTON, WA 98584 ceipt No. �O S1 6-
Re v
PHONE (360) 427-9670 Amount$ �00 m
PROPERAW DATE: CHECK APPLICABLE ITEM ✓ El
/ 0
MAILING ADDRESS G DAYTIM PHO E: NEW SYSTEM
2vV, 3/ REPAIR SYSTEM
CITY: STATE: ZIP: MAINTENANCE REVIEW m
P D Z SINGLE FAMILY 9
PROPERTY DDR S : Q e/ OTHER
SPECIFY: 3
SPECIFIC DIRECTIONS FOR LOCATING SITE: r5;79- PRIVATE WELL
COMMUNITY WELIJPUBLIC SYSTE
SYSTEM WFI#
SYSTEM NAME I_1
G�Ou/Y' TK APPLICANT \�+
l Z 74 NAME IN
Name of / , �/ Lot �-7� _ft. x��ft. MAILING DRESS
Installer o
Size: „_acres TELEPHONE y.
Name of um er o SIG 0
Designer Q Bedrooms Z X N 1
PLOT PLANy�p��"�/
Draw a dimensional plot plan, //
including: o
Wrecise location of tq�77,,n
holes,showing
measured distances t lJ LS
property boundaries.
'.Entry road;other roads, DEC 3 11997
driveways. PERMIT ASSISTANCEr/
NOTE: DO NOT DRAW IN CE NTER �7 //IN `
SYSTEM DESIGN f/ra ai1v
OFFICIAL USE ONLY,DO NOT WRITE BELOW DOUBLE LINE.
SOIL LOGS (hol4C.5 loCa 6C-C44-
TAT Nock H I MAtupnU6
30% slopes hekw/
5(SNDy I.OKMti
Post '- k { CUA
6-44' Wfrjralll( Do/got aomw4ttoq
$Q/ff$�10aw.— Depth frog Original
VV Grade to estrictive
Layer or ater Table: In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIRE WENTS
Finding Score Designer Level: 0 One YTwo
Soil Type
Veo&,�, �' Septic Tank Daily
i n t �4� in. 'nw Capacity: 10W Gal. Flow: zoo GPD
Slope kiltfh— 0 %. �t Appl, Infilt.
/0
Parcel Size Ac. �l _ Rate , �Q GPD/FT2 Area 400 iFT2
Distance to Shoreline C ft lb FTota11 Ins ctor I
to
COMMENTS/CONDITIONS FOR APPROVAL /
�S1�l?W �l �� 217` �QQ42r71
•All septic systems must be designed and installed by contractors certified by Mason County Department of Health Sery ces, unless prior approval is
granted by the department,or the design is by a professional engineer.
•Septic permit approval does not imply other building site requirements (i.e. RLC,Water Adequacy) have been met.
•Any change from the specified use of the property or any site alteration affecting the system design may invalidate this Dermit.
This Permit expires 2 years from date of site inspection.Denial of this permit may be appealed to the Health Officer with n 10 days of denial date.
SITE IEW: DES REVIEW: Approve -j Not Ap ro ed INSTALLATION:Cl pproved ❑Not Approved
BY: DATE: BY' DATE: BY: DATE:
TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy