HomeMy WebLinkAboutSWG95-0340 - SWG Application - 5/18/1995 MASONrCCXJNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG 95- C y
426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date y: o
PHONE (360) 427-9670 Aneceip?$o.
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HECK APPLICABLE ITEMS 3 <
MAILING ADD ESS: DAYTIME PHONE: NEW SYSTEM V\ o
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�0 / REPAIR SYSTEM °
CITY: STATE: ZIP: MAINTENANCE REVIEW �}
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PROPERTY ADDRESS: OTHER Z
SPECIFY: 3
SP CIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL
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--f SYSTEM NAME
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NAME fy, ;
Name of '� MAILING ADDRESS o
Installer N•% ��/r Z �c/ Lot ft. x ft. , w2 o IW
Size: acres
Name of = TELEPHONE 60 2G• >30
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Designer um SI NATUR ? a,
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Bedrooms X
Draw�'QRr�RSional plotq�, jZ
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T DRAW jE� Z /j` 1 /2 6 z d
(—'N!MIFM DESIG
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OFFICIAL USE ONLY. NOT WRITE B W DOUBLE LINE.
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Z SOIL LOGS tj
Depth from Original
Grade to Restrictive
Layer or Water Table: In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Finding Score esigner Level: Two
Soil Type f
Vertical Separation fn in. Septic Tank Daily Capacity:
Capacity: / Gal. Flow: J(a GPD
Slope 2' % Appl. Infilt.
Parcel Size 2'S Ac. Rate O GPD/FT7 Area 09 FT2
Distance to Shoreline FTotal Inspector Date
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COMMENTS/CONDITIONS FOR APPROVAL
•All septic systems must be designed and installed by contractors certified by Mason County Department of Health Services, 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 th s ecified use of the property or any site alteration affecting the system design may invalidate this permit.
This Permit ex 2 years from date of site inspection.Denial of this permit may be appealed to the Health Officer within 10 days of denial date.
SITE REVIEW: DESIGN REVIEW:0 Approved -j Not Approved INSTALLATION:O Approved ❑Not Approved
BY: DATE:,S'!i2t I fT BY: DATE: BY: DATE:
TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM:Applicant's Copy
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r 3701.09
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}.nclAHORT PLAT OF PORTION .- i t' _e
91/2 OF THE NW I/4,OF THE NE I/4 rr _
y SECTION 36,TOWNSHIP 21 NORTH, RANGE J WEST, W.M.
MASON COUNTY, WASHINGTON AUGUST, 1979 !;
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Oiatances, co.rose and features era illustrative only.
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1, 1, and4 shell not be used for On-wits @oral* disposal Of d0111M 1 t 1
atructure,rithwt vritten approval of the Beeon Cwnty Bealth Offlosf, c S
ROGER D. LOVITT d ASSOC. xHRAMS 9.F? •
P.O. 80X 816
,t SHELTON. WA 98564 TA/RDL I"=15V 1519
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