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HomeMy WebLinkAboutSWG92-0680 - SWG Application / Design / As-Built - 9/14/1992 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. c — a MUM SITE EV L ATIO ESIGN AND INST TION or m l( &A6 Date / o2-d Date s. y 426 W. CEDAR/P.O. BOX ice!/SHELTON,WA 98584 Receipt o. Receipt No. 0 0 PHONE (206)427-9670 Amount$ Amount$ m Z'aNN E C.iiit Q r=L.c CHECK APPLICABLE ITC MAILING ADDRESS: DAYTIME PHONE: INSTALLING NEW SYSTEM 'TO $o X III Y3- 91073 REPAIRING OLD SYSTEM CITY: STATE: ZIP: EXPANDING SYSTEM _ m `DNc<-�Lv--�R WA SINGLE FAMILY ✓ L m PROPERTY ADDRESS: OTHER Ed z EYt 0 c�ct aN D2/�E SPECIFY: 3 SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL or M ti nkc o. QlPI>,8c J sake PUBLIC SYSTEM r SYSTEM ID NUMBER v7 `141✓Y /-EFT as rr0 ark-&A U&N IDOUagW 81 rC- 0 A3 SYSTEM NAME 2r APPLICANT n R i4 r o NAME NE Name of Lot "3 o X S r7 ft.x //9 y-9/ ft. MAILING ADDRESS a Sax a Iu Installer ` wA- 47 v, Size: _D�acres TELEPHONE o 3- 67 <. Name of umber o SIGNATURE 0 I� Designer Bedrooms X ' l �q .cuiLrt PLOT PLAN g. Draw a dimensional plot plan, �� / I C including: i ® o o M k9 o ❑Precis i cf� holes, n r measu s a ce o ` y 3' y property boundaries. pp So a r l a r ❑Entry road;otheAg s,1-4,�1992 Q o driveways. — r fir® �i'a'�1 Pc)r NOTE: FLNLtyrl�iv L� FiF�E SYSTEM G ^ I A OFFICIAL USE ONLY. DO NO WRITE BELOW OUBLE LINE. SOIL LOGS ��4 �4 L41�h'h Zb 31 � laArhy �A�Or�(lJ1vY'ly.� �f.Q "�� Q�11.�J �rla ba�� 2q_3q J"LL4 .Leosc 3°�'�SZ m>Ep G,RAvt£uy �-..�1��(�Rn,,►tbt,`1 L�`1 �b �'oAp R.otrtS To Za u Ssn.lo -�+,�ts�L� ��,s�►Ho jK;;TV6WS Ib Z9Deth from Original /4 H4 0$I als- 1h07'/LR44 Grradeto F esstrictive (� Layer or ater Table: ?�'—In. DESIGNER DESIGNATION SCORES MINIM M SYSTEM REQUIREMENTS Soil 0 �(,p� Design:KLevel One ])Level Two _ 4�f rl, � Vertical Separation _ Septic Tank Daily O Capacity: (2M Gal. Flow: 3G0 GPD Slope �} Appl, p Infilt. Dept" rom rigma Parcel Size R— Rate of p GPD/FT2 Area YSD � Grad to Bottom of Absorption area: _ In. Distance to Shoreline Total _ S Ins for Date COMMENTS/CONDITIONS FOR APPROVAL A\A i U-f c'N ► -LL St-jjft`Xr A4C( ka tNG W I�CCS. e((3^tWiiQ &ner/Designer/Installer must meet on site to verify precise system layout 6 inter observations required xtreme care needed during site preparation to reserve existing topsoil Any change from the specified use of the property or any site alteration affecting the system design ali ate this permit. This Permit expires 3 years from date of issue.Denial of this permit may be appealed to the Health I w hi 10 days of denial date. SITE: A p p rove d Design Required ❑Not Approved DESIGN: Approved ❑Not Approved INSTA proved ❑Not Approved n" CIV�KcC91�( DATE:-Z(-�1Z BY: DATE:U,s Ni' BY: DATE2- f-f_l TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy v , ( QWAENTIONAL VM= DESIGN FORM PAGE ONE aws.r aaouss PARIM ZDOTIMOTZOt i Applicant's Name IJ/9t1��1�-Irr ' Prop. Owner's Name �GpYNe� Mailing Address �� //ISO Y 6 G Prop. Street Address UkJ gf SN 4 a 7 .Lv n �Y t�M Ly Aa�essor'a Parcel No. 1 3 -OaV /2 subdivision �a �� 40 f <'�.. ��' LOLL •...Y�!) (MY� v1�LOA Ml •)�''� 0 atom LD - oSlr OCT 3 0 19.92 DBSZGN PARANi M • No. Bedrooms Daily Plow 360 gpd • Soil Type Who A2 • septic Tank Capacity gallons • Application Rate � I� !t+ • Site Characters ® Level C loping • Trench/Bed Bottom Area 5 y !t= • Depth Eras Finished Orads to Top of septic Tank ------T �� inches • Depth from Original Grade to Bottom of Absorption Area at Dpwnsloye tdge -- I i/ hnches • Depth from Oeiginal Ora" to Sottom of Absorption Area at Obslope idge ---+. 2 yl gbZi • ,Depth of Cover over Absorption Area -+ —- Z in*ee • Elevation Difference Between euildiaq Sewer inches and Fixed Reference Point • Suildinq Sewer stubout is OSigher Lower than Fixed Reference Point • Reference Point Locations N z---- cfa me I DES.iGRRR CONS Alm CMZTMM 1 j I� i �c61WENfIONAL SYSTM DESIGN FORT[ �- PAGE ONE awon.a 01VO& sz, PLOT MAN ON i S Gat� acle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . : : : : : : : : : : : : : : : : : : • k : : . . . . . . . . . . . � . . . . _ . _ _ . _ . . _ . . . . . . . . . . . . . . . . . . . . r . . . MSX mt pwr PrAn CaMOM sT © scaled plot plan if lot is under } acres 0 Location and dimensions oo reserve area © 8xistinq and proposed well, iacludinq El 8ttildiags, roadways, e844ents, parking wells within 100 ft of property lines { C Property lines Topographical features, cuts, banks © Direction and percent of lope s C] Location and orientation of curtain Building stub-out } drain & all absorption are components C. ■ LO P-PL� Y '! y •�& 1 Y 1 .a lt'� I ,y\yS ��'+( yT�� f N t i i 3 ^ � v r 1 1^ l •a .. Yr " 4 II t Y / Yp S ALE lot 3 � ,}taAl `�Y e I" 1 .d•AF Rl }"� + � � M1'' ' � F ., a 1 � V� ' .'p t �' , ` 1 "t ' � vim' •,, ,'. �" " � , '.r` �'"�; p d . • A rl 4��R " Y i t �'' r Al • r F♦�Fj �k ".A .ar^+y A•1" `'• y. I ♦ - r 15 ! � f V" A ,.t5,.,, � ,a 4� r A.r " w4 1 i} 4+♦ St �e c , }f^fi �ti �, d " '• " wr v vt� t�`TT'' r M .9' 17! i wi�., 4w''d„?n Il+f.q,A. 'aJ cr I ;%r f.: , � +1 {;' �ir'n r• \ ,`.3'7.4f :. �sv1 0 � �¢ g ;,3} r` y 1%0Y � .r Ac r N� ', Sao•° I! GeriG I J . a b• //.`S. .59 ; 6 rx,: � i., Y 1 r i •cd'"k9 ••'iLt �` 3:< " dr' { 3,Ao1 "• ^.4 A. r q, "a r'_�«',4�, 4�:��°, iL J� .J w�,�Y',}�t• s. I � r �� , � �y ,.��. C(S!lVZWMNAL 'S4'STEK DEUGN FOBS!sagPAG]L ONE •µ LAW= 052= , > i .5 17 . . . . . . . . 1 :II . ACV P.f¢Vj �/�SP t n• PITY r I - • • • . f . y . . . . . . . . . f 3 I ORlZOWIA LAXWr ONE= CRBCXLM I I ® Lateral placement within bad Flaw splitting details t CONVj biTIONAL SYSTEM DESIGN FORM - PAGE ONE »..s«a csinrex � srsrnc �oss-s�iau 1 . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . `,' . . . . . . . . . . . . . . . . . . . . . _ ' GAG l� va i O '��a . .� . .3 . s. 1 lease . . . . ao� >t� aa�as x�sars , The undersigned designer agrees to !told Mason Oonnth DOPartmait of health mmless in the went the system installed is accordance with this design fails to operate as #eTtised by Mason County Health code. In addition, the undersigned designer dose, ©does not, wive the req t to be notified by the installer of the installation and given 38 hours to perlorminal inspection prior to cover. •L�w�avNr'. M�L�M! N� The enders reviewed and approved The undersigned certifies the eyatem has this du f of Mason County beat isst&UAd in full with this of dssigo ( Jul WORM: MASON COUNTY DEPARTMENT of HEALTH SERVICES Mason County Bldg.III 426 W.Cedar P.O.Box 186 Shelton.Wostungton 98584 =6)427-9670 • Beltar..275-4467 I (� _ Secttle:4U-6968 • Other 1-WO-562.5628 environmental health personal health water quality Final Inspection Septic System Date: TFine: Installer Applicant/Owner: L, y-�Q,1 Date of Permit.Z/c//f� Legal Description: Parcel Number: 3 Subdivision Name:1a,YNFj -Div: Block Lot:�Z Staff Initials: i