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4Q. PAR�.
THURSTON-MASON HEALTH DISTRICT DATE BASIS FOR FEE AMOUNT UMBER
DIVISION OF ENVIRONMENTAL HEALTH -
529 WEST FOURTH 110 W.K ST P.O.BOX 746
PHONE 753-8073 PHONE 4264407
OLYMPIA,WA -98501 SHELTON, WA 98584 D
OWNER _
P.O. PHONE DIRECTIONS T TOTAL
334 _. ; r _ ,,Z FEES
SEWAGE V REGIJNAI F�tNNMI'NG =='J-
CONTRACTOR� P-Ii ,1.:.. _ [R a,.� I -:;y T-J nL _ T-� .-01'7 ,
ADDRESSOR
LOCATION
NAME OF PLAT f -Lpf /
NO. SOIL TYPE E' - �: �. :,•:.,.,;� y_
3 '. R* ee- .My 3
�JDEPTH TO WATER TABLE—FT.
WATER
SOURCE ❑PUBLIC ❑ PRIVATE PERC. TESTS: INCHES PER HOUR
TYPE OF �?O:Y:d •J : LOT :� BY: DATE
BUILDING BASEMENT - SIZE—X`
NO.OF NO.OF GARBAGE PRIMARY t ��< SECONDARY
BEDROOMS 3 BATHS DISPOSAL SEPTIC TANK IS) GAL. AERATION GAL.
SPACE RESERVED FOR ,
REPLACEMENTS DISTRIBUTION FIELD SO FT. DISTRIBUTION TILE TOTAL / FEET
NORTH - SITE PLAN AND SPECIAL STIPULATIONS: TRENCH BOTTOM AREA S �� SQ. FEET
1 i I QUANTITY OF I
APPROVED STONE I CU. YD. SAND—CU. YD.
f'JSQ' JlF2/+�1�- i�spTt -31
FILL REQUIREED//ii �J CU... YDS. / +,
THE ELEVATION OF THE BUILDING SEWER SHALL BE SUCH THAT
THE MAXIMUM DEPTH OF THE DISTRIBUTION TILE SHALL BE BE.
,�i TWEEN 12 INCHES AND36 INCHES FROM FINISHED GRADE TO
I I o TOP OF TILE UNLESS OTHERWISE STIPULATED BY THE HEALTH
OFFICER. IF THE ELEVATION OF THE BUILDING SEWER IS TOO
!' LOW TO MEET THESE ELEVATIONS, A SEWAGE EJECTOR MAY BE
REQUIRED. -
`� ISOLATION STANDARDS FOR PRIVATE WATER SUPPLIES:
BETWEEN WELL AND TANK OR ANY PART OF THE TILE FIELD,
Q II 1 100 FEET FOR SINGLE RESIDENCE, MOBILE HOMES, DUPLEXES
AND MULTIPLE DWELLINGS. NO DRAINFIELD WITHIN 100 FEET
OF ANY WELL, FRESH WATER LAKE OR STREAM;1 OO FEET FROM
v j ANY SALT WATER BODY.
z IPi66ohs NOTE: "FOOTING DRAINAGE, DOWNSPOUTS, WATER SOFTENER AND ANY
—OTHER WASTE WATER NOT DEFINED AS SEWAGE SHALL NOT BE CONNECTED
TO OR DISCHARGED INTO THE SEPTIC TANK SYSTEM OR THE SEWAGEAISPOSAL
AREA". ALL SEWAGE, INCLUDING SINK AND LAUNDRY WASTE; MUST BE
IlU 1 CONNECTED TO THE SEPTIC TANK.
C'f F' K / FINAL INSPECTION REQUIRED BEFORE BACKFILLING
OFFICE USE ONLY TO BE BACKFILLED
AFTER INSPECTION
DATE APPLICANT MUST CALL FOR INSPECTIONS LISTED BELOW __ I2" TO•21� _
/SITE APPROVED ❑ NOT .
APPROVED (i P STRAW
BY:- t✓/ y``�j STONE
SEWAGE: ❑ APPROVED ❑ NOT (/ OVER TILE
APPROVED O i.
- BY: E� STONE
NOT BY: - ' UNDER TILE WATER: ❑ APPROVED ❑APPROVED
�, CROSS SECTION OF TRENCH