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HomeMy WebLinkAboutSWG92-0051 - SWG Application / Design / As-Built - 5/14/1992 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. — SITE EVA UATION DESIGN AND INSTALLATION Date i€ o 5: m 426 W. CEDAR/P.O. BOX 186/SHELTON,WA 98584 Receipt No Raeceipt No. PHONE (206)427-9670 Amount$ Amount$ m f PROP TY OWNER: DATE: 3 m y N L Cl CHECK APPLICABLE ITEMS ✓ m m INSTALLING NEW SYSTEM MA NG�D ESS:K e 2 DAYTI Ep m. G�gb�rT REPAIRING OLD SYSTEM CITY / STATE: ZIP EXPANDING SYSTEM m BL D 1✓ 8� SINGLE FAMILY �/ $ OPERTY ADDRES�: / e / eLN OTHER SPECIFY: SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL m e a bUx� le Ff 7 kke >Q� PUBLIC SYSTEM n SYSTEM ID NUMBER SYSTEM NAME IN APP LICANT NAME 5 d c I_ Name of Lot ft.x ft. MAI ING A ORE S Installer �_r M z Size: C acres e s u o Name of Numr of SIGNATU E// " I Designer rn Bedrooms 2 X ' L PLOT PLAN '2 5 Draw a dimensional plot plan, including: I 111�5 00 v < x ❑Precise location of test a 4g �' �x (J (J µ IO holes,showing welt measured distances to x i properly boundaries. I q G x f w 91Q v ❑Entry road;other roads, S/' �� S i , driveways. r p�� qJ NOTE: DO NOT DRAWN mew Ie SYSTEM DESIGN 7f t DO n I� OFFICfAL E ONLY. DO NOT WRITE BELOW DOUBLE LINE. T� SOIL LOGS MINIMUM SYSTEM REQUIREMENTS t,../ �—7 g 6 F"', •S Design:&,I�avel One ❑Level Two 7,,{ S�1r�Jurc 6 sl,Stit>> cic,sc ✓/ t 4 Ar Septic Tank Depth from Original ,�" �crsc 6elo,..� 'S ('' Capacity: 1D," Gal. Grade to Bottom of j 703 is 6 I, ila, Absorption area: 19 In. 31" L.tc Daily Appl. Infilt. a(, b — 49 " kt-c S Flow 2.40 GPO Rate 0'8 GPD/FT2 Area 32t0 FT2 �eCA s 4�.cta+.c 4J 2D'j Vertical „ Inspector Date cHse bclo J Separationy36 6 COMMENTS/CONDITIONS FOR APPROVAL: pp �r PPt K vL- 0-(,a �d / Z m� �.bisorp�an 'Ore" ch' �3 y b 40 +ke {-,-e &e a s"'i Do h?�' ��r bad s/rSde++. (err, 4bnerMesigner/Installer must meet on site to verify precise system layout ❑Owner must arrange pre-installation conferences with health dept.staff Mer observations required ❑Extreme care needed during site preparation to preserve existing topsoil Any change from the specified use of the property or any site alteration affecting the system design may invalidate this permit. This Permit ex i ears from date of Issue.Denial of this permit may be appeal-d -_ the HeaRh&car within 10 days of denial date. SITE: roved O Not Approved DESIGN: p ad O Not Approved IN TALLA ON: Approved ❑Not Ap ed 'AY: DATE: ��ly/q2 BY: DATE: 2 BY: DATE:b A TOP: Health Dept. Copy BOTTOM:Applicant's Cop,41 MASON COUNTY DEPARTMENT, OF HEALTH SERVICES POST OFFICE BOX 186 SHELTON, WA 98584 (206) 427-9670 FAX 427-8425 M DATE: June 10, 1992 E M O TO: Greg Hasbrouck R A N FROM: Brad Banner D U M RR: Jerry Glavin Design !!!q!!!IElf!!IIltt!!!I1!!!!!!EEl E lE itltll!!!l iillElllEl l!!!IE!!lE31 iEllll3liE1!!!3l IlElillltilllElltl1111 iilltlll ll!!ill111❑ttililitllli❑itlilli l 11 1111111111111!!A lIII3tE1 tltlll! Your design for the above referenced parcel has been reviewed and is hereby approved. K PARCEL IDENTI?ICATION Aoolicant's Name !ailing address � � < , oroa. Owner's Name YYearAr6n.� //IG V Yt 00, pois e l9 3 G ?ron. street Ad--ess �70/� ;k�rLseu Qot S{�21'Fo., -wtx 9�.e11u.i -we ciaY aa�a- sip alsY �a-a- sio assessor's Parcal No. 32 3 �.� 96903a Subdivision (S.+—lv--a Lola MWr—a) {per—�ai�i�l�w/a1011•/LrYs> D JUN DESIGN PARWrTXR5 • No. Bedrooms Daily Flow _ 2410gcd • Soil Type i rs©• Seatic Tank Capacity gallons • Aoolication Rate 16 god/ft3 • Site Character: C3 Level © Sloping • Treneb/Bed Bottom Area YOo ft= f" gk • Oeoth :ron Finished Grade to Top of Septic Tank -------------------------- inches • Depth from Original Grade to Bottom of Absorption Area at Downslooe Edge — inches • Depth from Original Grade to Bottom of Absorption Area at Doslooe Edce inches • Depth of Cover over Absorption Area / inches • Elevation Difference Between 8uildiaq Sewer Stub-Out and Fixed Referents Point 2 inches • Building Sewer Stubout is ClBigher ©Lower than Fixed Reference Point • Reference Point Location: f DESIGNEE COMNiS AND CONDISIONS i . � � dwisW Oa/ZZ/93 PLOT PLAN I I 1 I 1 I I I 1 1 I I 1 I I I I 1 I 1 1 1 I I 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . p . . . . . . . . . . . . . dal, M ;le's . . . . . . . . . . . . . . ,a'. . . . . . . . . • . . . . . . . . . . %-f . . . . . . . . . . . . . . . . . . . . . c . . . . . . . . . . . . . . . . . . 3� . . . . . . . . . . . . . . . $ r .. . . . . . . . . �qn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DLSIMM PLOT PLAN CIMC== Scaled plot plan it lot is under } acres C Location and dimensions of reserve area Existing and proposed wells, including 3uildings, roadways, easer..ents, parking wells wi_.`.ia LCC ft o: zrc-_er_1 lines ?ropert.r Lines Topographical features, cuts, banks QDirection and Percent of slope Locacion and orientation of curain drain S all absorption area components '-- 3u L'ding stub-out DRAnM=.D LAYOUT DEMM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ORA-1. Tv" LAYOUT DZTXM C32LXLIS l 11 LEVEL ONE DESIGN FORM - PAGE FQUR s. %i (34/22/92 / SYS= CR=-SdC;ZON . . . . . . . . . . . . . . . . . . . . . . . . SFrbOvfie�vloD •Tank inrl� `f38 _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tdp }Q•te r�l zy,Ve t e tv )jj, I raI Teo ery q-7 i3o � nf=ra��nu eta G/7. . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . %he uadersiqued agree not to hold Hasoa Cannty Oepartsieat of Health responsible in tam event the system installed in a=rdaaee with this design fails to operate as required by Mason county Health Code. a r•w t• • w�l�k•�w• aNw�rr� • O..-r•w�r Oesignsr waives reVirement to be actified of installation and givea�48 hours to Lanett the pr_br to final cover: Cl rj xs?Sn�r ►v i�l Lpe� Yes No r�an�a.•r- s e--.•n-r I '.`.e undersigned has reviewed and aoproved The undersigned cer___:es --he syste^ has cn.s dos:^n a banal: of Mason County Teen installed in full ac_ardance with V%Is a; sisal rvices. design. �- 6 nLYgz MASON COUNTY DEPAR'YMENT of HEALTH SERVICES Mason County Bldg. III 426 W.Cedar P.O. Box 186 Shelton,Washington 98584 (206)427-9670• Bettor:275-4467 Seattle:4646968 • Other: 1-800-562-5628 environmental health personal health water quality Final Inspection Septic System Date: 6 y_ � Installer: //f)5ASiJ-W11, UV- � O Applicant/Owner: L n U 1 /j Date of Permit: U Legal Description: r o? / Parcel Number: Subdivision Name: ' Div: Block: Lot: Staff Initials: �—