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HomeMy WebLinkAboutSWG93-0988 - SWG Inactive - 7/27/1993 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG c H 426 W. CEDAR/P.O. BOX 1666/SHELTO A 985 4 ' Receipt NO.Date 9 3 y o . o v; PHONE (206) 427-9670 3 gmount$ ' 0 z ifPROPERTY OWNER D p I • H '7�23 93 CHECK APPLICABLE ITEMS �e m < m MAILING ADDRESS: DAYTIME PHONE: INSTALLING NEW SYSTEM q 2122 00 20(,35.Z - ,f 4.31 REPAIRING OLD SYSTEM m CITY: STATE: ZIP; EXPANDING SYSTEM m O LYr I i A lJ/t:. 9 SSo Z_ SINGLE FAMILY PROPER ADDRESS: LoT of SNo2•r �Ar oa Lor sµar Ar OTHER Z tj iCWEL50&J Q,-I SPECIFY: 3 SPECIFIC DIRECTIONS FOR LOCATING SITE: 1`r µae ro. o^-rt' o PRIVATE WELL Cr Ai AY 3 uft.) /AKE LAP]LAP]i lkio p T h,L, Qn. PUBLIC SYSTEM 3 SYSTEM ID NUMBER To H I L b507-> r i I V u r i c.�Gr S�'� �O APPLICANT SSYSTEMNAMEz� ED S Y- n e r F�,a 6,5m. $vr6 (3(_T- pwz-c--(_ o AJ r, NAME S uNaY dcuT�c T Name of Lot sec 1'1L) PEA. 14U ft. MAILINGADDRESS E .26TO ,¢ Ara o Installer ft.x 4e;u-rc-) A. 9$SIt4 IW Size: O 40 acres 1 1 TELEPHONE 20( 4.26-4r7Z Name of m I-f- Desi ner um r o SIGNAT R >� c g Bedrooms 3 X A, /s�+d� PLOT PLAN NOTC%OWI+m WnuLp L, kE TO 66 I- Drawadimensionalplotpian, MC)TIFIED AniO P[WS +T- Ou2iu� �76\� Ft including: 1 NS p gc T l oat» '55 I W e? w ❑Precise location of test `�- holes,showing , Qp 5 measured distances to �5 G M��,c¢ 4 property boundaries. °�'' ' �oT To t) ❑Entry road;other roads, C1 Aw u L C �dj/ O'40A` driveways. NOTE: D IlY" SGE ArrncKFsu S�ro2r YSTEM DESIGN P,A-r 4n 0 Vic-i w lrY 1 KD �°t 3-bl 13 ONLY. DO NOT WRITE BELOW DOUBLE LINE. SO LOG � Cn ofn 1-7 1AK gio el"o I /'mil alo Depth from Original Grade to Restrictive Layer or Water Table n. DESIGNER DESIGNATION SCORES MINIMUM SYST EOUIREMENTS Finding Fsm7e r6 gner Lev "Ifft� Soil Type 71 Vertical Separation in. f Septic Tank � Jl Daily / - Capacity: Lti1J Gal. Flow: at0 GPD Slope 3 % e qppl // Infilt. Parcel Size B'•n^Ac. ern Rate © vb GPD/FT' Area Distance to Shoreline z-�GA! ft. Total V` Inspector ;n Al Date �j, C�` O �! COMMENTS/CONDITIONS FOR APPROVAL use V Any change from the specified use of the property or any site alteration affecting the system desiggn may invalidate this permit. This Permit expires 3 years from date of site inspection.Denial of this permit may be appealed to the Health Officer within 10 days of denial date. SITE: Required ❑IA�roved DE SIG p ed ❑Not Approved INSTALLATION Approved ❑Not Approved BY: DATE• rrff�� BY: DATE:/-/-F y BY: DATE: TOP: Health Dept. Copy IDDLE: Designer's Copy BOTTOM:Applicant's Copy f, - MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 166,6 SHELTON, WA 98588 (206) 427-9670 FAX 427-7798 APPLICATION FOR RE-EVALUATIOR a 0 w D OCTDIRECTIONS 2 u 1v� ..................................... .............................................................:::::::::::::::::::::::::::::::::::::::::::::::::: .......................... C�ENEI, PERVICES 1. Complete Part 1-3 and submit to the Director of Health Services, PO Box 186, S e ton,NE WA RA 85 2. The on-site lead will make a determination in Part 4 whether a reinspection is justified. When a rein- spection is made, the findings of the second Environmental Health Specialist are written in Part 5. A final determination by the lead is recorded in Part 6. 3_ Applicants are billed an additional $40 when a reinspection is required, and are expected to pay for any necessary laboratory costs associated with soil tests, unless the health department is demonstrated to be in error concerning soil type. 4. Findings and determinations of the lead may be appealed to the Mason County Health Officer at the ad- dress listed above. PART 1: REQUEST FOR REINSPECTION /� • Applicant's Name: eb zx/T& • Address: F I MIffK SE AI SNEt7-e.y • Telephone: ( .20ti 1 427 - 2 455 L f L o S. • Ases3 QQ �� b99 � � sor s PrC� DlUmer iamean J� • Health Department finding being disputed by applicant: n n U Anticipated depth of watertable U Soil t n ype/application rate u Depth or presence of mottling IV n New drainfield area to evaluate lJ Other (please specify) PART 2: AUTHORIZATION APPLICAN DATE Z9V ';Qr� 7 h:re-eva Lw Revised 08/24/94 PART 3: PLOT PLAN Use this space to draw a detailed plot plan, or attach one to this application. A detailed plot plan is one that shows the precise location of the test holes, existing septic systems, dimensions of the property, and location of any wells, roads, or other buildings on the property. I I I I I I I I I I I I r3 I I I I I I I I I I I I I I I i I � I I I I I I I I I I I I I I I I I � Ali T I PART 4: DETERMINATION OF LEAD .............................................................................................................................................................................. .............................................................................................................................................................................. .............................................................................................................................................................................. n u Reinspection is justified. n u Reinspection is not justified, for the following reason(s) : On-Site Lead Date h:re-eva L.w Revised 08/24/94 PART 5: REINSPECTION FINDINGS SOIL LOGS TEST HOLE #1 I TEST HOLE #2 z S,C ljo 4AaM I j6- 3354A)DLoan+ 3z —GGs rneaSANo 3 3 - o% y✓c V� AND I I I I I I I I I i DESIGNER DESIGNATION SCORES Parameter I Finding I Score Soil Type Vertical Separation I G6 in. I Slope I 3 ; I 6 I Parcel Size I .,�,OAc. 1 u I Distance to Shoreline I p ft. l I Total: t MINIMUM SYSTEM REQUIREMENTS Parameter I Requirement Designer Level ( f Septic Tank Capacity I ! :1 ° gal. Daily Flow I 3!'U gpd Applicaition Rate I gpd/ft 2 Infiltrative Area I b�U ft2 I OTHER COMMENTS / v -aw- 9y EfiV ironmental a lth Specialist Date Ll It PART 6: REINSPECTION DETERMINATION .............................................................................................................................................................................. On-Site Lead Date,,, JJJ......___,,, Billing Amount Receipt Number h:re-eval.0 Revised 08/24/94