HomeMy WebLinkAboutSWG94-0040 - SWG Application - 1/12/1994 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG Ll Ll — c y
426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date Receipt No. o 0
PHONE (206) 427-9670 Amount$VHWERTY OWNER: z
DATE: W
Q r h i Z_ CHECK APPLICABLE ITEMS ✓ 3
m m
MAIL NG ADD SS: DAYTIME PHONE: INSTALLING NEW SYSTEM q
r b REPAIRING OLD SYSTEM
CITY: STATE Zlp; EXPANDINGSYSTEM
QQ j<_AlY' � Z SINGLE FAMILY R
PROP RTY ADDRESS: OTHER Z
`L %{ L4 t I AW A _ SPECIFY: 3
SPECIFIC DIRECTIONS FOR LOCATING SITE: I PRIVATE WELL
PUBLIC SYSTEM
SYSTEM ID NUMBER
SYSTEM NAME
APPLICANT
NAME �A4
Name of x A Lot ft. ft. MAILING ADDRESS
Installer A/T A� S l,�
�" A" z8: �� acres Name of TELE E !-
Designer Number of SI RE a M
Bedrooms 0
PLOT PLAN Ica
r_Draw a dimensional plot plan, � ( S19 T' �SI
including: �/y4 �3 .`II F�rt_p"r_t
❑Precise location of test �p r+ U' _ C01_X2i _v6 4s
holes,showing F fnJ(_1 �✓measured distances to /a � 3 I I O
property boundaries.
❑Entry road;other roads, o
driveways. Q
NOTE: DO NOT DRAW IN
SYSTEM DESIGN
OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
SOIL LOGS
U,tr Ge1Qw
&oqe — 1k Vie= 6k M aho 00 trz&,q
'f C
Grade to Restrictive8Dei�th lY�
Layer or Water Table: In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Finding] LSMel Designer Level: ❑One ❑Two
Soil Type
Vertical Separation in. Septic Tank Daily
Capacity: Gal. Flow: GPD
Slope %
APpl. Infilt.
Parcel Size Ac. Rate GPD/FT' Area FT2
Distance to Shoreline (t. Total Inspector Date
PO COMMENTS/CONDITIONS FOR APPROVAL
lea' J bV h65 �s 2-�l� he �
Rjr 2d r la0� � i� ray n 'road,
V
' �Any change from th e use the property or any si e a Vifloing�e sy"Ste designmayinvali afs thi perit.
This Permltexpires 3 years fr of site Inspection.Denial of this permit appealed to the Health Officer within 10 days of dental date.
SRE: Approved ❑Design Required U Not ppmyed DESI Appro} d ❑Not Ap ovty �WLATIO�- ApprovadU oted
BY: J1 DATE: F�J BY m u DATE: 7 aTE
TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM:Applicant's Copy
MASON COUNTY
DEPARTMENT of HEALTH SERVICES A A A
' Shelton,Washington 98584 N• Cp 5T I N.. �
(206)427-9670• Belfalr.275-4467
ENVIRONMENTAL HEALTH PERSONAL HEALTH ��� WATER QUALITY
P.O. BOX 1666 303 N. FOURTH P.O. BOX 1666
MASON COUNTY DEPARTMENT OF HEALTH SERVICES 10 LU &N
SHELTON, WASHINGTON 98584 �raji..nL^�
claimant NOTICE AND ORDEn-
yg, December 29, 1993
Mr. Berube
P.O. Lux 45
Tahuya, WA 98588
The owner, reputed owner, or tax
payer of the real property involved U
described as:
Auditor's Tax No. 32205750010
Notice
NOTICE IS HEREBY GIVEN that the Mason County Department of Health Services has
determined the lack adequate sanitary facilities on the property in question is
a violation of WAC 246-272'and Mason County Ordinance Article VI.
Findings
There is a non-permitted pit privy serving as a septic system. This lack of
adequate sanitary facilities has been determined to contribute to a severe public
health hazard and constitutes a public nuisance as defined by RCW 7.48.130.
Order
YOU ARE HEREBY ORDERED to abate the health hazard and public nuisance in the
following manner:
1. A plan of action and repair permit application must be submitted by
the responsible party within 30 working days of the date of this
notice and order.
A. The plan must indicate the name of the designer and installer.
B. The plan must indicate the repair system will meet the
appropriate Marine Shoreline Standards outlined by Washington
Administrative Code.
2. All system repairs and corrections must be completed within 60 days
of the date of this notice and order.