HomeMy WebLinkAboutSWG96-0193 - SWG Inactive - 3/27/1996 PERMITON O.ES
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MASON COUNTY DEPARTMENT OF HEALTH SERVICES — WG W- CDj1!9 rn y
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426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date_ y: o
No.Receipt _ 7 s o
PHONE (360) 427-9670
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Amount$ ) Z �
IJHUPERTY
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�, CHECK APPLICABLE ITEMS e/ <
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MAILING ADDRES . DAYTI(v1 rON NEW SYSTEM o
0� 00V k 'jj GG((pp z5so REPAIR SYSTEM °
CITY: STATE:S / zlp; MAINTENANCE REVIEW e t d All J g �8 � SINGLE FAMILY 8
PROPERTY ADDRESS: ea
a OTHER
1,Ql� 6 r 6s ez SPECIFY: 3
SP CIFIC DIRECTIONS FORodL1OCATING SITE: PRIVATE WELL m
TD d1pS0m (k .0, •-'!Tura) keF- A#.'A 7urN R,'Vkr COMMUNITY WELUPUBLICSYSTEM
SYSTEM WFI# I�
OAI /14: /Bahr cQ- O ,dNµ,'!¢ uvh� IP ,a- 0u rave! Rc . 8 SYSTEM NAME
r o ev,'f ,u b 07-/v S �e1 bf Rou N APPLICANT
NAME 'e Imo.
Name of MAILING ADDRESS
Installer .D cs94
Lot �ft.x ft. IW
Nameof Size: �/3 acres TELEPHONE
Designer um ero ', SIGNATURE o V�
Bedrooms X 0
PLOT PLAN
Draw a dimensiorlan,
including: kip
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❑Precise Iota test 5 Q F
holes, Ni C1'
measured astdp )C lye 'QG
property b ies.^ 07 /l yam, CUP O
❑Entry roas�`tlier roi,
driveway . Q A�
NOTE: D T DRAW IN } /•36 IOU
DESIGN '
OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
SOIL LOGS
e�) -lq -)APDy,40AAA is-IL2- rl� 3
3 Lbcaw-. 6- /7SAA)ayLocaw•
3� c per Gig• sAN� 17- -tS JMo-WL-lSrc-/loaw,
Depth from Original
Grade to Restrictive
Layer or Water Table: In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Finding Score Designer Level: ❑One �wo
Soil Type —4t- Z
Vertical Separation Z in. 15� Septic Tank Daily
Slope O
Capacity: Gal. Flow: 3 L O GPD
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Parcel Size / , 3 C-Ac, a Rate e I Area
Rate GPD/FT Area FTz
Distance to Shoreline ft. Total 1 -7 Inspector Date
COMMENTS/CONDifi6NS FOR AP ROVAL
•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 RE W: DESIGN REVIEW:O Approved -j Not Approved INSTALLATION:O Approved ❑Not Approved
BY: QL DATE: S BY: DATE: BY: DATE:
TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy