HomeMy WebLinkAboutSWG98-0330 - SWG Application - 7/10/1998 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG c
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426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date l y: o
PHONE (360) 427-9670 Receipt No. % 0 y
Amount$ Z F
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_ _ 9 CHECK APPLICABLE ITEMS ✓ m
AILING ADDR SS: DA IME PHONE: NEW SYSTEM o
(1J. 1 53Valy _ _ -7 REPAIR SYSTEM `2
CI y��TAI'T Zlp; MAINTENANCE REVIEW w
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PROPERTY ADDRESS: OTHER Z
t • SPECIFY: 3
SPECIFIC DI CTIONS FOR LOCATING SITE: PRIVATE WELL m
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APPLICANT
l3Gw>c �YQAI ,Q, r t �Gi NAME O 4 ty IV ee 1, C. A
Name of Lot 321
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Installer Y / -03 Size: /0. .5 acres o
Name of LEPHONE
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Designer d 1 Bedrooms X
PLOT PLAN JIK (a3. 9
Draw a dimensional plot plan, -�
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❑Precise of test t� �161
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measur Ista to ❑ a6 L grope da. 3
❑Entry roia otheO ads,
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OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
f \ ** 2 SOIL LOGS
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DESIGNER DESIGNATION SCORES MINI UM SYSTEM REQUIREMENTS
Finding Score D igner L wo
Soil Type I• Z-
- Septic Tank Daily
Soil Depth ?/ in. �
' -� Capacity: /� Gal. Flow: p GPD
Slope Appl. Infilt.
Parcel Size GD ,J Ac. Rate (0 v6 GPD/FT' Area FT'
Distance to Shoreline 7J ff. Total Z Inspector Date
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COMMENTS/CONDITIONS FOR APPROVAL
•All on-site sewage systems must be designed by a Mason County Certified Designer or a Professional Engineer.
•All on-site sewage systems must be installed by a Mason County Certified Installer,unless prior approval is granted for a homeowner installation of a gravity system.
In such cases a preliminary on-site meeting between health department staff and the homeowner is required.
•On-site sewage syste n approval does not imply other building site requirements(i.e.RLC,Water Adequacy)have been met.
•Any change from th ifi use of the property or any she alteration affecting the system design may invalidate this permit.
•This permit expires s om the date of site review.Denial of this permit may be appealed to the Health Officer within 10 days of denial date.
SITE REVIEW: DESIGN REVIEW:❑Approved ❑Not Approved INSTALLATION:p Approved ❑Not Approved
BY: AZ DATE: BY: DATE: BY: DATE:
TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy