HomeMy WebLinkAboutSWG93-00078/79 - SWG Application - 2/2/1993 ON-SI?E SEWAGE SYSTEM SITE EVALUATION AND DISPOSAL PE,8 T,m ,
PERMIT NO. d5chJacfMASON COUNTY DEPARTMENT OF HEALTH SERVICES _ � N
SITE EVgLU O 'DESIGN D INSTA IJ1TIO a
Date -� Date ? y
426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Receipt No Receipt No. CD
N
PHONE (206)427-9670 Amount$ Amount$ a
PROPERTY OWNER: DATE:
JAMES WOLD 2-1-93 CHECK APPLICABLE ITE S {/ R m
MAILING ADDRESS: DAYTIME PHONE: INSTALLING NEW SYSTEM XX m
841 Daley St REPAIRING OLD SYSTEM E
CITY: STATE: ZIP: EXPANDING SYSTEM 'd m
Edmonds, Wash 98020 SINGLEFAMILY 2
PROPERTY ADDRESS: OTHER ro z
E 3308 N Island Drive SPECIFY: 3
SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL proposed XX
Harstine Island, left after bridge, 500 ' past PUBLIC SYSTEM
SYSTEM ID NUMBER I N
Community Hall, bear right down gravel road. SYSTEMNAME IN
APPLICANT
Go through gate & follow signs .
NAME Emerson I r
Name of Lot So ft. x \ L\ MAILING ADDRESS 6 016 NE Bothe 1
Installer �5 W Suite 119 Se IN
Size: acres TELEPHONE ( 206 0 6 488-
Name of Number of SIGNA ( 11 o 101
Designer Bedrooms 3 hcIM
PLOT PLAN Himlie Realty, C.
Draw a dimensional plot plan, "�� 46
including: w
0 o
U Precise location of test F
holes, showing I I o
measured distances to y
property boundaries. 2' . I o
❑Entry road;other roads, 4 Sr t'r$ R
driveways.
rl 1J
NOTE: DO NOT DRAW IN - \ \. C\\ <5C;) ® �-1 V,'—k,,\
SYSTEM DESIGN
7 � ecsn\u\k IV
2
OFFICIAL USE ONLY. DO NOT W LOW DOUB I - M•
SOIL LOGS
_ #_ -4b cv tic
0 IQt Sql (( -Irp
a'jc 6�l511 S � lrtu/�,, �v"9✓21�
I 24 Fi qt v I (6 22` C4
ry ttid �
tnnaWQ FIva SWvo 17-2-7 St 14 c(- ( s}� ,�Oc �E t�
, f i v�2 S✓i �b
uMi co WCIzA �7 `i Vvd t Si l' +s o4 laob S�nJ)
PQ S� CI-�, 22-y,�n _�`"°'qeko Fi1-c s`stid
to Ga.3 O� lCd� Gepthrade froR Otrictiv
nal
Grade to F�estrictive
r )1S a� �ocYt 33 Layer or Water Table: 15 In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Finding ScoreJ Designer Level: ❑One 9�Ywo I
Soil Type a__S ✓✓
Vertical Separation 3 ( pfs Septic Tank Daily
Capacity: 'Z Gal. Flow: .3 �6 GPD
Slope < (S`Ia Op+s A
Parcel Size I.2 'lc 6 }S ape. / A ea
5 Rate , 10 GPD/FTC Area 6 C) FT'
Distance to Shoreline 7'*:o 4 0ph Total t7 Ins ector Date
✓-�L e 3
n/� I COMMENTS/CONDITIONS FOR APPROVAL
00 LALA ✓'ew�b�e vary i�pl l -t✓al-... +LL, h�,
[,.e i'
Any change from the specified use of the property or any site alteration affecting the system design 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:O Approved esign Required G Not Approved DESIGN: U Approved ❑ Not Approved INSTALLATION:O Ap roved ❑Not Approved
BY: J , DATE: BY: DATE: BY: DATE:
TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM:Applicant's Copy
`ON-SITE SEWAGE SYSTEM SITE EVALUATION AND DISPOSAL PE . .ITT
MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT
SITE V LU ON DESIGN ND STA LATI
Date Z 3 Date ≤. m
426 W. CEDAR/ P.O. BOX 1666/SHELTON, WA 98584 N. o
PHONE (206) 427-9670 Receipt No. Receipt No.
Amount$ I Amount$ z
PROPERTY OWNER: w m
CHECK APPLICABLE ITEMS ✓ 3
James Wold DATE: 2-1-93
MAILING ADDRESS: DAYTIME PHONE: INSTALLING NEW SYSTEM q
841 Daley St. REPAIRING OLD SYSTEM rn
CITY: STATE: ZIP: EXPANDING SYSTEM v
Edmonds, WA 98020 SINGLE FAMILY 3
PROPERTY ADDRESS:
OTHER rn Z
E. 3308 N. Island Drive SPECIFY: 3
SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL rn,
Harstine Island, left after bridge, 500 ' past PUBLICSYSTEM
SYSTEM ID NUMBER N
Community Hall, bear right down gravel road. SYSTEM NAME
APPLICANT
Go through gate & follow signs. NAME Pat Emerson
Name of Loth ft. x _ft. MAILING ADDRESS6016 N.E. Both 1
Installer a Suite 119 Sea tle W 81�
Size: \ .a5 acres TELEPHONE 206 488— 503 <
Name of Number of SIGNA URE. (1aEt o N
Designer Bedrooms Shale
HIMLIE REALTY, I
PLOT PLAN
Draw a dimensional plot plan, ges�c -� I U
including: i 2 e �V m
t �
O Precise location of test U1
holes,showing Jj 33c .V V _}
measured distances to x /' o
property boundaries. S
r o . Q r o
❑Entry road;other roads, 1
driveways. \6y.Ad \ y11
4 a5o �fi ( 15yc sfo N
NOTE: DO NOT DRAW IN S { o
SYSTEM DESIGN f n �4
330 CiHf
OFFICIAL USE ONLY. DO NOT WRITE BELOW DOU L '
SOIL LOGS f {
S."I>
a-t; ,Lt Y I,Lt Is3oh1 5H- bLti lo'4'
C-IS" g�Aatlj 5'i J-i I {
2- ato"- F/victwt t®ww� - ac .4 'J FA Q spa
j -3 " ,t1Led t. iec-tf h¢/ea tsv 5+ Ib - t'VtdH(er!
Ittfted ti •�I-` rods lb 33"
C
SAtnd ' 'D JO-El" V'.mflLd Cow- ✓CW wa,1-F" T,1t) 3 P Depth fro Original
r�,ris+o 26 FMe S"Q Grade to F estrictive
CQvt a v,I c d Fie 5v3 rod+3 dD 3g " Layer orV ater Table: oZ In.
c S ° tG MINIMUM SYSTEM DESiG%NATION SCORES REQUIREMENTS
J
Finding Score Designer
Designer Level: ❑One 9�two
Soil Type - ✓//\\\
i- Septic Tank Daily
Vertical Separation I S S Capacity: 1200 Gal. Flow: GPD
Slope I (4 Appl. Infilt.
Parcel Size I ?5 it• O S Rate (o GPD/FT' Area :T'
Distance to Shoreline O Total 2 Insp r Date
fo O
COMMENTS/CONDITIONS FOR APPROVAL
Cu h4t\,\ wt Iv\c tnut 4-t Tl c I szp�,A fiOU1. You tCi a L.
4-o did 4 s - Ana leS �s L k t w, PL I at. 00 I io+ (" \
�o`RSoi l -- 1 �e lad , Flo i�n �o ��Y ��'^Lv +L t JQld(A W,
Any change from the specified use of the property or any site alteration affecting the system design may invalid to 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:O Approved Design Required U Not Approved DESIGN: ❑Approved ❑Not Approved INSTALLATIONA Approved ❑Not Approved
BY: ç DATE: ZI WlcII BY: DATE: BY: DATE:
TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy