HomeMy WebLinkAboutSWG96-0191 - SWG Inactive - 3/27/1996 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG c y
� n N
426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date a co W.
o
PHONE (360) 427-9670 Receipt No. o H
Amount$ 'Z £
it — N U So ✓ 3 --.27- 70 CHECK APPLICABLE ITEMS 3
MAILING ADDRESS: DAYTIME PHONE:, NEW SYSTEM
9 oX S REPAIR SYSTEM —
CITY: , I STATE: ZIP: MAINTENANCE REVIEW m
i4 2.1 to N a) SINGLE FAMILY �
PROPERTY ADDRESS: OTHER Z
O�PaA)Jtr�f 4 R zee SPECIFY: 3
SPECIFIC DIRECTIONS FOR LOC TING SITE: PRIVATE WELL
MASON K U JE N I.QF-t— o IM04C 'TD COMMUNITY WELUPUBLICSYSTEM li
SYSTEM WFI# W
NkelSaN R Ure1 U .O rnl Q; ki— SYSTEM NAME I�
APPLICANT
6N r D MelQ — r h�' 6h1.60?kSr`d6f ` e�
Name of MAILING ADDRESS p, FaX
Installer Lot ft. x ft. (V
s et t wit 78s
Name of Size: acres TELEPHONE *3(, y K Ir
Designer Number ot SIGNATURE o
Bedrooms X
PLOT PLAN
Draw a dimensional I(t)
including: �G G—ZfT?4xxyto4w. u�q-s
.4 W
❑Precise locati�(test V SiC'�.Cc�a w� r.�/h o1y(.�s
holes,showiip!�,t\� �
measured dfs3 Es to^ /1. 5eek% Rs I j Z
property b es. ^Q
0 Entry ro �noSLier roa�, �'✓C/
drivew ''�3�� �� Q
NOTE:DRAW INS
S M DESIGNQ'
G+(
OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
SOIL LOPS
�07' / See
y>n6Lfs
d ' Depth from Original
7� 35 r Grade to Restrictive
Layer or Water Table: In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Finding Score Designer Level: ❑One )kf Two
Soil Type L
Vertical Separation Lin. 7 Septic Tank Daily
Capacity�� 00 Gal. Flow: 3 60 GPD
Slope L d
Appl. Infilt.
Parcel Size rJAc. f Rate GPD/FT2 Area v v FTz
Distance to Shoreline it. Total 2 Inspecto Date
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 the specified use of the property or any site alteration affecting the system design may invalidate this permit.
This Permit expires 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:O Approved j Not Approved INSTALLATION:O Approved ❑Not Approved
BY: 7 DATE://S L BY: DATE: BY: DATE
v TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy