HomeMy WebLinkAboutSWG97-00888 - SWG Inactive CB53 CD
MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG —
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Date <. o
426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584
Receipt No. � N
PHONE (360) 427-9670 Amount$ Z f
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7 W
PPLICABLE ITEMS {/
S Z EM
MAILING ADDRESS: x 1 S � DAYTIME PHONE: 12.
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CI E: �1 CE REVIEW 0
T MILY
PROPERTY ESS: N16 wR SPECIFIC DIRECTIONS FOR LOCATIN SITE: ELL Cr
COMMUNITYWELUPUBLICSYSTEM
SYSTEM WFI N
/.4111 ST TU/?/��/66fT ON SYSTEM NAME I N
APPLICANT
dF� 9OUE . E 970 NAME6 I\
Na Lot ydf X 27 "ft.x ft. MAILING ADDRESS . O.
Nafl
�l` 5-AL( L7D/v, NA I W
Size:,.. _acres TELEPHONE
i ie Number o SIgNATU
134 0
Def;goer : Bedrooms ���/tc�r rvyWaotc,w�
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PLOT PLAN +6r�w ��
Dra nsional &t plan, m
t{ tr � j/ys
inch z tJ� IDDp t r ! I✓7(l� � / �
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LV rA--7 � � �f�j¢�/!r�n•'A�M Fs Oh ed�r anc�'to
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aysLL F OVRVE�IIED
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NOW DO NOT D%W IN 7� JEW>4y PE�2G [ ��
e-,-SYSTEMO&BIGN � �E' 41
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OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
// SOIL LOGS -.e 3 a --1Y' Lre ,P
�f �-�/1�1 mil/ 0-- a -f /D-0x--,v sm>�
D -/02 si.u0 1QM -/a M W all- 36 /a2,•„yS-C e
36 - Nab /ou. y San
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DESIGNER DESIGNATION SCORES - MINIMUM SYSTEM REQUIREMENTS
Finding Score Designer Level: ❑One ){Two
Soil Type
Septic Tank Daily
Soil Depth I in. �� Capacity: 1�O Gal. Flaw: �gD GPD
Slope -Z % D APPI Infik.
Parcel Size « ) Rate Q.4 GPD/FT' Area 80p FT'
Distance to Shoreline >X0 ft• 1) Total Insp or ate
f COMMENTS/CONDITIONS FOR APP VAL
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•All on-site sewage systems must be designed by a Mason County Certified Designer or a Professional Engineer,unless prior approval is granted otherwise
•All on-site sewage systems must be installed by a Mason County Certified Installer,unless*or approval is granted otherwise.In such cases a preliminary on-site
meeting between health department staff and the homeowner is required. '
•On-site sewage system design approval does not imply other building site requirements p.e.PILO,Water Adequacy)have been met.
•Any change from the apecified use of the property or arty site alteration affecting the system design may invalidate this permit.
-.An
perms expose 2 years from the date of site review.Denial of this permit may be appealed to the Health Officer within 10 days of denial date.
S� DESIGN REVIEW:❑Approved O Not Approved INSTALLATION:p Approved ❑Not Approved
BY: DATE: BY: DATE:
TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM:Applicant's Copy