HomeMy WebLinkAboutSWG2023-00201 CANCELED - SWG Inactive - 5/23/2023 OFFICIAL USE ONLY
DATE RECEIVED: 3 I 3
MASON COUNTY � ��' �
COMMUNITY SERVICES AMOUN EIVE : RECEIVED BY: W 0)
Public Health(Community Health/Environmental Health)4111/
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3 6642 7-96 70,ext.40C or 360-275-4467,ext.400 S W G w „� �'3 — OO O N
415 N.6tn Street-Shelton,WA 98584 P'\`1/�/\) _O
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ON-SITE SEWAGE SYSTEM APPLICATION 3
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APPLICANT PHONE m
Steven Allaway 360-519-9846 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE
8259 Pelican Ln. SE, Port Orchard, WA 98367 rn
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SITE
N. TrailheadELoop, Lilliwaup 32434-50-00032 ^/ 1-46, cio' .T,CITY,ZIP CODE
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NAME OF DESIGNER PHONE
Tim Quayle - Quayle Septic Designs 360-440-4249
NAME OF INSTALLER PHONE 0
none yet
PERMIT TYPE(select one) DRINKING WATER SOURCE 8
Iof RESIDENTIAL OSS 11 COMMUNITY OSS h'1 COMMERCIAL OSS b- PRIVATE INDIVIDUAL WELL Il PRIVATE TWO-PARTY WELL Z
Into
TYPE OF WORK(select one) PUBLIC WATER SYSTEM Olympic Trails
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W NEW CONSTRUCTION/UPGRADES rl REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE IX REPAIR
SUBMITTALS ❑ SURFACING SEWAGE 0 EXISTING FAILURE ❑ SHORELINE Ca
DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r
6 WAIVER(S)(IF APPLICABLE) 2 .37 acres '
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
Take Hwy 101 to Jarstad Creek Rd. - turn west on N. Olympic trails Rd. - turn left at second
N. trailhead Loop Rd. - property is on the right and flagged.
Drainfield area is cleared. o
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. i..
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER: _
1 INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
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SOIL CODES: RECORD DRAWING AND INSTALLATION REPORT
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED)ISSUED BY DATE
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
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