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Home My WebLink AboutLARGE LOT PLAT - LRG Application - 12/16/1991 R l ENVIRONMENTAL HEALTH DIVISION SHORT SUBDIVISION APPLICATION 3o�b3Jr- rlG¢- 0Cb10 Date: /o?- //0 -9/ Receipt No: S Plat for: Q5r �141j71 - A16/2A O Address : p��d y� -. .J1lri �i� Phone_ �oSy' ;? Directions to Property: _ G xxy- Assessors or Trea urers Legal Description: ( include 12-digit parcel number) ,h 09*__ — <56eL tz)t�s — i LUv Lot Area 1) sq.ft. 2) sq.ft. 3) sq.ft. 4) sq.ft. Slope: g % % 8 Name of Engineer, Sanitarian or Designer: Address : �G / /S _ A , Phone �t4f= ,y Is there any salt water, lakes, creeks, swamps and intermittent streams or wells in the plat or within the 100 foot boundary line? Comments: �ti��i �� iR 'J � /a�jLL�l9�7 !.Ut4 * * * * * * * * * * FOR OFFICE USE ONLY Required I Submitted Reviewed Approved PMethod gs II Analysis I I I i 'On-Site Management ; ! I Water Supply Info Sanitarian Comments : Approved by: Date Sanitarian Signature MtSON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 186 SHELTON, WA 98584 (206) 427-9670 FAX 427-8425 L1 a✓ C Q.. `-h c- PROPOSAL: u " r " �r Sbcrrr ri�c_� CLA.k V.'S1 \ yl COMMENTS 1. Each proposed parcel can support on on-site sewage disposal system meeting the requirements of state and local regulations. Yes LL No Yes, conditional on the following: Lot 2 ,1 Mt W. 1 jj .12 orl o StI.t �o L .� kn tit\ Q v AL1_ olla , nF'c ru r C c I e - n —_� 2. Drinking water will be provided by: dIndividual wells El Public water system NOTE: If water is provided by a public water system, we recommend the system have the appropriate approvals and be constructed prior to final plat approval. 3. Proposed parcel sizes meet the requirements of WAC 246-272-090. Yes, using Method 1 Yes, using Method 2 No 4. Soil evaluation table is attached for review. Yes El No S. Other comments are attached for review. El Yes El No COMMENTING OFFICIAL: DATE: $P.OPOSAL: 1) r V\ e v 1, aL } COMMENTING OFFICIAL: DATE: SOIL EVALUATION TABLE PAPA101T1R �''� Two r w� G•. 1Y SLvi.. E Soil Type Minimum Lot Size i i Groundwater Depth' Vertical Separation' 1 System Type' I Soil Log 11 ........................................ ........................................ ........................................ ........................................ ........................................ Soil Lag 12 ' Soil Type: Soil at the anticipated depth or the bottom of the adsorptions area is typed according to VAC 246-272-094. ' Minimum Lot Size: Determined using wacar system type and soil type according to MAC 246-272-090. ' Groundwater Depth: Depth from original grade to zone of seasonal or psrJnent saturation, and defined In VAC 246-272-020, and evtdenced by seeping or standing water, or by mottling. vertical Separation: Depth to restric#1 a layer (anticipated depth of saturation or compact soil) from anticipated depth of the bottom of the adsorption arms. ' Syetmm Type: System Category In Immediate area of test holes, either conventional or slternative. in] commercial • residential �E S O', L oc5 To r 5GO-+ f�prn¢ f S$O wf . QaynolCAS q�jS3 � Co`f' I t 0-1v,5.1 )oow� (0�1-221�,3an� )ow w. _ yy r !o -36 w -4e.fn �� w.•.Paa oo.rNY Inca _ 22�'32�, S+rvctu^eQ Ste..& 4�us) 'f'�-crovc,I +o loos.:.sow/ l-glwwc� in A \\ 32-4b cov^poc� 9rou.r,1 ....... Cof-� <, -- 4� a-6 loo w�_. ll ..... !,�-24" Soy (oar w'sll gru�e s . . ..._..2�11�-2." S�i�{��•I toti. cC+ loa."I 4u,.a 2411_?6" ,�191.�•IY eor.Ppcl- gu,.ay (law. ; . 1 42^l o' �1ac;e { i l 36-roD" $\uc741 441 ) ..... . . . . ........ . . . Lb .. S • o-(: s;111aa. , L.,�(c: O^lOuS:Ilr )oaw� kft., 4 s.Nall Nall t o�3Zu S 1o�..t stATcQ ��i-�y �eo� sor.t. 5.^. cd.r,��cls o do - I�b36e� SC.+Ny IDf.... 50w.2 S�'n.sYAVt�S t0�^3oSo.+dL 1 co ^ Sore- tM. 4rt�,451 �r... 4Z. _4'IYV f. n� S•N" �OQ.+� 70^ Q'OA S�i 1,, Sr 0''0r� mac+ S; 5 42 Go" StIPCial SOI, IO�S rGt:oruCA. 11/Irof 4� .. µVS"{ov� EK Ga Jt.L� hB .- Office&Shop•S. E. 1320 Arcadia Rd..(206)426-0550 9 Fax(206)427.5835.Shelton WA 98584 . h ATTENTION; NANCY r imMason County Department of General Services F. 0. Box 166 NOV 2 71991 Shelton, Wa. 98584 ENERAI SER lies Nancy, Thant:: you for being so helpful on the telephone yesterday. The soil logs, to go with the pert tests sent in on 11-15-91 for subdivision approval on Phillips Road , are enclosed . Please contact me if there are any questions or problems. Thant = again . Sincerely, 1 S. Scott Horner 580 W. Reynolds Avenue Centralia, Wa. 98531 Day: 754-77111 Ext .268 MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SHELTON, WA 98584 aK(t= (206) 427-9670 FAX 427-8425 APPLICATION FOR SHA&T• PLAT EVALUATION Receipt No: 3o9I INSTRUCTIONS Date of Payment: ) 22 — i (o — 9 1. An application in considered coeplots when the fee is paid and the following elements haw base addressed: • Parts 2 and 2 of the application farm seat be cOsPleted. • one properly excavated backhoe pit per proposed parcel seat be ready for inspection.. Properly excavated pits are 6 ft deep with a 4 tt deep shelf on one and of the pit. The a ft deep shelf seat slope up to the ground surface for easy ingress and agrees. • A scaled plot plan set be attached to the application. The scaled plot plan scat ahoy the precise location of the test holes, dimensions of the Property, and location of My existing or proposed wells, roads, or buildings within 100 ft of the Property boundaries. 2. After a completed application is received, staff will impact the Property and provide the applicant with a written report. If the project requires more assistance than the NaluatiOn Of fear test holes and completion of this report, an hourly rate of 317/hour as set forth by the lawn County Board of Health my be charged to the applicant. Havised 09/01/92 PART 1: APPLICANT/PARCEL IDENTIFICATION . : ......... ....................... .... .....::..... ..........................................:.................................................... .......... 1.L 1 • NAME OF APPLICANT . S C.v CT l� O r�( �1�C v • TELEPHONE (10 4 S ;" 3 h • NAILING ADDRESS 5 D W . �Q.�IVto Y.LIS d. ,.a , uA g8S31 easy � ^1 sFay f� • ASSESSOR'S PARCEL NUMBER 3 2. 3 - 7 ,1 - Q 0 4 • LEGAL PROPERTY DESCRIPTION — An • LOT SIZES (ACRES OR SQ FT) — F'�vt 1• Cr¢. (�d�r GQ,Q� Lp6 1 L06 ] L06 � LOC � • DIRE IQNS FOR TING SITE £ C-U 01, l 11C.�� Z dv� ' N7r L- OV-, 2. C f 1 V C v e- . il.0 _ 2,0130 fF-. 12 PART 2: INTENDED USE OF PARCEL ..:.................. ':•. ::i ..... eeiiei9i)iieii :.; .. .......... ... • INTENDED USE OF PROPERTY (Check One) : Single family residence Multi-family residence Other, specify: i • WATER SOURCE FOR PARCELS (Check One) : Individual wells Community well Short Plat Evaluation PART 3: HEALTH DEPARTMENT REVIEW (OFFICIAL USE ONLY) €€ SOIL LOGS AM SITE CIUMACTZRISMS 1 LOT P Tar • `Z LOT s LOT s 'T Test Pit A Test Pit A Test Pit A Tot Pit A •SLF E A TrA cNEb S) I F CAj10J,jS Depth of soot pen.: Depth of soot pans Depth of soot pas.: Depth of soot pen.: _ Depth of mottling: Depth of mottling: Depth of mottling: Depth of mottling: _ Depth to seat. layer: Depth to rest. layers Depth to seat. layer: _ Depth to Zest. layers soil type maws soil type (USDA): sail type (USDA): Doll type (USDA)s Teat Pit s c Teat Pit s Test Pit s 3 Test Pit s Se(= AT Pc_1-4F0 sri PPL1C-A110 S Depth of root pen.: DR" of root pen.: Depth of root pan.. Depth of root Pm.: — Depth of mottling: Depth of mnttli g: Depth of moetlingt -- Depth of.mottling: _ Depth to rest. ]ayar: Depth to rest. lapat: . Depth to rest. layers Depth to rest. leper: Sail type (UNA): soil type (U®A)s soil type (USDA): Boll type (Us"): Curtain Grain goaded? Curtain drain goaded? Curtain Crain needed? atstaig drain needed? slope (a)t slope (%)t slope (%)s slope (e)t shoreline? (Yn)t shoreline? (Y/m): shoreline? (Yn)s shoreline? (YIN): ninin m lot size:' miniM,E lot diet' Minimum lot airs:' Mialmom lot size: ' Minimsm lot size applies to one, subdivisions and is defined as the sin•== allowable law ares par residence or resides- tial equivalent (150 gallons par day). - CONN== ll NQ CncF �oQae dka �t � no 2-- vev-4�r3.�Q �Qtr.)tiA ¢i �_ Syt'Q - Revised 09/01/92 i Short Plat Evaluation PART 4: HEALTH DEPARTMENT REVIEW SUMMARY (COMMUNITY DEVELOPMENT USE) APPROVE After examining lot size, proposed water source, and soil type, it is the de- termination of Mason County Department of Health Services that each proposed parcel can support an on-site sewage disposal system meeting the requirements of state and local regulations. ® DENY After examining lot size, proposed water source, and soil type, it is the de- termination of Mason County Department of Health Services that each proposed parcel cannot support an on-site sewage disposal system meeting the require- ments of state and local regulations. This determination is based on consideration of the following factor(s) : BOLD APPFANAL UNTIL IDR=NR ACTIONS ARE TAffiN EY APPLICOET i After examining lot size, proposed water source, and soil type, it in the de- termination of Mason County Department of Health Services that each proposed parcel cannot support an on-site sewage disposal system meeting the require-/meats off state and local regulations until the following conditions are met: i L > �J ow 1i. +�A.�LgLttj ® conatim(s) re"ired prior to apppsoral have bean sore by the applieant. • N jr y 3r10 official Date I G PART 5: APPROVAL SIGNATURE ................. ................................ ...... ............................... :::.................::::::::•:::::::::::::::::::::::::::::::::::::::::::::. ..........................S:i::i?:.......... .......................... i .......................... .......................................... :::::::::....... :::2:i:::i::::::::::::::SS:i::SSf::::::::5:::::::::5:2:::::::::::�::::::::::::::::::::::::::::::::::::::::::::.. . ... ...................5:::::::::i::i:::::...... i I i Health Official Date Revised 09/01/92 SEWAGE SYSTEM PERMIT APPLICATION >�L Permit Expires'- f ! MASON'COOM DEPARTMENT OF GENERAL SERVICES FOW DEPARTMENT7 USE-ONLY : o ENVIRONMENTAL HEALTH DATE BASIS FOR FEE f'-AMOUNT :I RECEIPT+ 426 W.CEDAR/P.O. BOX 186/SHELTON,WA 98584 PHONE(206)427.9670 , APPLICANT �- `� e Not Approved ADD RE S3 PHONE BY'' '��hC Ov,iL Ij A , , cIT - zips ESIGN SYSTEM REQUIRED PROPERTY OWNER ` INSTALLATION: O Approved Cl Not Approved ADDRESS - PHONE �( BY:" CITY zipDEPTH TO WATER TABLE 'ASS / Ito` T1t SEWAGE � pE SQEL T YPE; i ErE s CONTRACTO' µ� I SICNER( ,N s'J U (t II LEGAL DESCRIPTION a ZL4 �. TYPE OF 1I��'' NO. OF LOT BUILDING /NLZL�L.�D1vV L BEDROOMS SIZE SINGLE RESIDENCE L_ PUBLIC WATER .- WATER SYSTEM SYSTEM ❑ NAME SEPTIC TAN ISI GAL. PEIMP RE.Q COMMERCIAL ONLY LIQUID WASTE c.P.D. pISTRtBUf30NTIL£TOTAL '._' FEET DIRECTIONS TO SITE: FILTRATION AREATOTAL ', SQUARE FEET".' FINAL'INSPECTION REQUIRED,BEFOREBACKFILLING: Y E, DEPTH OE BACKHLL 2'^STRAW OR PAPER' < STONE T 1�1 ••OVER TILE STONE SITE PLAN AND SPECIAL STIPULATIONS uNDERntE (INDICATE DIRECTION OF DRAINAGE) �".CROSS:SECTIONOF TRENCH " nff 0 w L lI,g {o y 1 INA��R LBV1--L- Tbco 1 44 I To rwL,,- - ANY ALXFQ&/ ivy SL ,SYS lNJ � ,-- N v ),o Qo- !vgw 7Gst— NDc>s t-2,� t� '9I \& wia- S'r7 L O "SaA Loz a-, �If t'ZG FlL LA✓L — 2.- 42+ H2rk 'riCL- ,IlTa- A PP2oVLsD LL q .9- WHITE-OFFICE COPY.YELLOW INSTALLERS COPY.PINK PPOPcR.v OWNE. C).1 -occN Py'1.^ •�%zcc. SEWAGE SYSTEM PERMIT APPLICATION `ht Permit Expires / l MASON'COUNTY DEPARTMENT OF GENERAL SERVICES FORrDEPARTMENT USF--ONLY t ENVIRONMENTAL HEALTH , DATE BASIS FOR FEE IAMOUNT RECEIPT-- . 426 W.CEDAR/P.O. BOX 186/SHELTON,WA 98584 �" PHONE(206)427.9670 v ' APPLICANT SITE: QARPcoved GNot Approved ADDRESS - PNONE Cl zIP� l (Z cr' DESIGN$YSTEMREQUIRED PROPERrr o NER + ' (� / �� / INSTALLATION: €]Approver}-: ❑Not Approved ADDRESS PNONE � '• ay.. '. ._ •• 14 CITY .^ DEPTH TO WATER TABLE 1,:2.. SEWAGE 1 WAGE SOILTYPEYg I TI"boo- L4. C)0 s CONTRACTO' ^.r\/ , pE51GNER .I R t 11 IEGAt DEXR210N t I 2 I b ' &" `-1 p TYPE OF NO. OF �j �L( LOT S-rp�,,� BUILDING S/N Gi�(., A.1 L BEDROOMS I!SIZE U/�_ ,31,E, •"L@)pyje,v_ ' '+ ,j#I'' �{ix. '7+' 't'"�--} SINGLE RESIDENCE PUBLIC WATER - WATER SYSTEM SYSTEM ❑ NAME SEPTIC TANK.(S) " " '—' GAL'. PLIMP 8EQ. COMMERCIAL ONLY - LIQUID WASTE G.P.D. DISTRIBUTICINTIL£TOTAL FEET,. DIRECTIONS TO SITE: FlLTRATiON'AREATOTAL SQUARE FEET'` ' FINAL INSPECTION REQUIRED BEFORE,BACKFIUING a e '.s� DEPTH OF cobe (+ 2"STRAW OR PAPER;':. », w; Pam, I OVER% TILE ` P[PE STZE ig SITE PLAN AND SPECIAL STIPULATIONS e-� UNDER TILE F- -- (INDICATE DIRECTION OF DRAINAGE) -� CROSS SECtIOrE'OF TRENCH oTti lZn-c o �L��q.tier- - iZO AD 3 3v �rts A 16 & 5> w41�- 7 WHITE OFFICE COPY.YELLOW-INSTALLEPSCOPY;PINK-PPOPEOw 1WNSP'S O0"'GPII ..."'.^'�G^5=' _ SEWAGE SYSTEM PERMIT APPLICATIOIN Permit Expires f 1 MASON COUNTY DEPARTMENT OF GENERAL SERVICES FOR DEPARTMENT USE ONLY ENVIRONMENTAL HEALTH DATE BASIS FOR FeE 'I AMOUNT RECEIPT#r 426 W.CEDAR/P.O. BOX 186/SHELTON,WA 98584 uv -- .. .. �• I PHONE(206)427-9670 APPLICANT �= ^�I �C;,� SITE: ❑Approved C7 Not Approved ALI ADDRESSp PHONE, - BY- S i CITY I� �r ZII� / DESIGN.SYSTEMR��EQUIRED PROPERTY OWNER INSTALLATION: El Approved L7 Not Approved ADDRESS PHONE J BY: DEPTH TO WATER TABLE CITY ! Y ZIP !r + R sJ SEWAGE SEWAGE SOIL TYPE:T�1 I G �'(' �`"L �A b J CONTRACTOR 1 DESIGNER T ri Sx+� L �rt+>E`� �:;kH'r�iM!�cT� r- � LEGAL ESGRIPTION ew 24 TW14 TYPE OF NO. OF 73�_,_I LOT }� TI BUILDING & n't(� OMS BEDRO �SIZE� ( tZ.� .r 3Ly lTi�. Vl U. Q' SINGLE RESIDENCE r6- PUBLIC WATER t0'r-o"J' '� WATER SYSTEM "' _ SYSTEM ❑ NAME SEPTIC TANK (S) GAL, PUMP REO, COMMERCIAL ONLY LIQUID WASTE G.P.D. DISTRIBUTION TILE TOTAL FEET DIRECTIONS TO SITE: ((�� FILTRATION'AREA TOTAL SQUARE FEET �- cr a �0% INAL INSPECTION REQUIRED BEFORE BACKFILLING i , �`7 N'UcG �k� L E BBAcKFnLL ON )- T'STRAW OR PAPER': STONE OVER TILE RPE SIZE E STONE SITE PLAN AND SPECIAL STIPULATIONS DNDERTtEE (INDICATE DIRECTION OF DRAINAGE) CROSS SECTION OF TRENCH 3cj (�?" `7xL:;*l I i Tcs_r OOLIVS i N WHITE OFFICE COPY:YELLOW-INSTALLERS COPY;PINK-PROPERTY OWN ER' RE:grv-BUIL 1 EPT.COPY zwrn SEWAGE SYSTEM PERMIT APPLICATION "hU Permit Expires ! 1 MASON COUNTY DEPARTMENT OF GENERAL SERVICES FOWDEPARTME WUSE-ONLY. ENVIRONMENTAL HEALTH _ATE BASIS FOR FEE aMouar : nECEIPT= 426 W.CEDAR/P.O. BOX 186/SHELTON,WA 98584 (t i � „rytr Eft? 1 PHONE(206)427.9670 l i APPLICANT SITE: ARProved' ^Not ADORE \ PHONE BY: ciry ZiP .. {y G tfi{ DESIGN SYSTEM REQUIIRED 7 PROPERTY OWNER INSTALLATION: 0 Approved ❑Not Approved � _ -'ter " •�ti� ADDRESS C- PHONE BY CITY /'� DEPTH TO WATER TABLE - ZIP '�5�� g1 SEWAGE SE SOEL TYPE: CONTRACTO- Lys rJ DESIGNER LEGAL DESCRIPTION TYPE OF NO. O OF �`LJ .�., BUILDING /IJ��L N L, BEDROMS ? SIZE A_ SINGLE RESIDENCE 19— PUBLIC WATER ' WATER SYSTEM SYSTEM NAME_ SEPTIC TANK fS) GAL ''.. PUMP REO. COMMERCIAL ONLY LIQUID WASTE G.P.D. DISTREBUTION TtLETOT%At FEET, DIRECTIONS TO SITE: FtLTRATtON AREA TOTAL`""' SQUARE FEET' 7 .,FINAL INSPECTION REQUIRED"BEFORE"BACKFILLING ' W . x z ��DEPTH OF BACKFiEL T`STRAW OR PAPEK`. F STONE �( .,OVE;;R..TILE PIPE SIZE, :•,, STONE ." SITE PLAN AND SPECIAL STIPULATIONS (( ppLIT (INDICATE DIRECTION Of DRAINAGE) ' t ^� i ,:', LE n"..LRoss:SEGTION OF TRENCH...- 33v T�71c) r W w5.u- Si7� 7 � 5 WHITE OFFICE COPY,YELLOW-INSTALLERS COPY:PINK PROPPRTY OWNEP'S COPY.GRPpry a.,IL.-. y,qco- SEWAGE SYSTEM PERMIT APPLICATIONS Permit Expires / MASON COUNTY DEPARTMENT OF GENERAL SERVICES�l FOWDEPARTMEW.LISEONL,)r.�,�- ENVIRONMENTAL HEALTH DATE BASIS FOR FEE AMOUNT '= RECEIPT# 426 W.CEDAR/P.O. BOX 186/SHELTON,WA 98584 1 PHONE(206)427-9670 APRICANi l_ r� ��"` SITE: OAPproved Q Not Approved ADDRESS PHONE ; BY: S�% L L=' n L ti;L�s Jib 75Y•7»,��S CITY ZII2 :Gs Q( DESIGN SYSTEM REQUIRED PROEERTY OWNER n _ INSTALLATION: ❑Approved CI Not Approved ADDRESS -K. ^�•�J�L.,` PHONE •� clTv DEPTH TO WATER TABLE > zIP �.„.. SEWAGE SEWAGE SOIL TYPE: ..,... COMRAfiOR �y L 1 DESIGNERt�. ) 1.1 `.�/Y L'ScUPM ,�f.Kl ,/Iy'xis-, l.-Et uuw,.� YY LEGAL DESCRIPTION 92 colyc� TYPE OF NO. OF 7`L, LOT C BUILDINGS,�?elsE_ ++f"1ul BEDROOMS�_S12E? C_ SINGLE RESIDENCE PUBLIC WATER WATER SYSTEM SYSTEM ❑ NAME SEPTIETANK:(S) .GAL...:. PUMP REQ. COMMERCIAL ONLY - LIQUID WASTE G.P.D. QISTRIBUTIONTILETOTAL •FEET'! DIRECTIONS TO SITE: FILTRATION AREA TOTAE SQUAREFEET "T p!�l ?� FINAL INSPECTION REQUIRED BEFORE•BACKFiLLING" Nic H(L-L;05 � DEPTH OF ID'ILL BACtLL. ON 'S-L- ,26� T (xx) -r->-r 2"STRAW OR PAPER LV L� '_'E\ +JC��Z, l``�11, F STONE OVER TILE P,.PE SIZE 55. - < STONE SITE PLAN AND SPECIAL STIPULATIONS uNDEanrE (INDICATE DIRECTION OF DRAINAGE) caoss SEGTIOrtoF•TH ✓ �-�ft S i T`t ` A N IIo,47a,D SEWAGE SYSTEM PERMIT APPLICATION `i ] Permit Expires f MASON. COUNTY DEPARTMENT OF GENERAL SERVICES ' • ENVIRONMENTAL HEALTH D TE BASIS FOR FEE AMOUNT RECEIPT? 426 W.CEDAR/P.O. BOX 186/SHELTON,WA 98584 (3�f PHONE(206)427.9670 ti �/4 APRICANT (�'y� SITE: 0Approved. =.' Not.Approved AODRESS \ PHONE BY: i` L,�> C'��1� cirvZII Z DESIGN SYSTEM REQUIRED PROPERTY OWNER INSTALLATION: 0 Approved Q Not Approved ADDRESS ) BY:. -: {� PHONf _ CITY � L '•,i t�LLir�-Z- �S �7��I k�S 1 ,� I DEPTH TO WATER TABLE ( •' .h IA. I cam; I ll.-Ir ZIP � TIA I. fi rr it +r SEWAGE SEWAGE SOILTYPE: V "'-7 ' ' "" � � u CONTRACTOR �L L. 1 DESIGNER ct - n LEGAI DESCRIPTION CT( 24 :A ��7� �—rjL� �3/-�, `ru 1 i Q 4 '1� ' t3sl TYPE OF NO. OF BUILDING STD L Z&-. JU( BEDROOMS 73`1- LOT SIZE J 1l— ' SINGLE RESIDENCE PUBLIC WATER - WATER SYSTEM SYSTEM NAME SEPTIC TANK(SI GAL: PUMP RED. COMMERCIAL ONLY LIQUID WASTE G.P.D. DISTRIBUTION TILE TOTAL. FEET DIRECTIONS TO SITE: (� FILTRATION AREA TOTAL SQUARE FEET E _T cD^1 L_ }=L FINAL INSPECf1ON-REQUIRED BEFORE BAEKFIL€ING 'nl F(ILL,(� ( � DEPTH OF BACKFILL:: • j '�L� ,�G( '� r (iYY� n (F T'STRAW OR PAPER F�STONE r (� OVER TILE ( .PIPE SIZE STONE - SITE PLAN AND SPECIAL STIPULATIONS UNDER TILE. (INDICATE DIRECTION OF DRAINAGE) cstos5 sECTiQN OF•TRElUCH,I ' 3 � 4-1k :z� sip t((( , 'FAO A D SEWAGE $YS7EM PERMIT APPLICATION Permit Expires f 7- MASON COUNTY DEPARTMENT OF GENERAL SERVICES • " ' • EWRONMENTAL HEALTH DATE BASIS Forr FEE AMOUNT IRECEIPT= 426 W.CEDAR/P.O. BOX 186/SHELTON,WA 98584 ) PHONE(206)427.9670 -1.1141 If APP,ICANf �• �' � r� \�;(> SITE: OApproved. CNot Approved ADDRESS �/c (� PMpNE �/ y'..1 : BY: CITY I r Z1 j � ) DESIGN SYSTEM REQUIRED , ate-ate. PRORERTY o ER INSTALLATION: QApproved CI Not Approved ADDRESS BY: CITY <f� t G ^F Z L� 7S� r7�/I C��J 124(. 9+ DEPTH TO WATER TABLE / I C:v' r ZIP /;J �� / 7/ CONiRACiOR c <�. e�1 SEWAGE �,I� SOILTYPE. l� - LP"�' DESIGNER ,�KI ,//H x��'1a� IEGAI 4ESCRIPi1DN ��c-)lye:TYPE OF NO OF LOT 'I��BUILDIING • •''�`T"1 eEDROOMS _SIIZE J — SINGLE RESIDENCE [t PUBLIC WATER WATER SYSTEM "-" SYSTEM NAME SEPTIC TANK fSi GAL.'': PUMP RED. COMMERCIAL ONLY LIQUID WASTE G.P.D. DISTRIBUTION TILE TOTAL FEET DIRECTIONS TO SITE: FILTRATION AREA TOTAL SQUARE FEET , 'FINAL INSPECTION REQUIRED BEFORE BACKFILLING ZL DEPTH s cKFIL LL L'. ON rLL, k f\-iJ V.^ L/XZ,.') "(��T" STRAW O R PAPER L J�� ` I JC��L, l'`�N STONE r CJ�VS a O OVER TILE PIPE SIZE STONE SITE PLAN AND SPECIAL STIPULATIONS 'UNDER TILE (INDICATE DIRECTION OF DRAINAGE) CROss SEtT�T� '. V Lp S w -sl- N OAb