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": o. , WA. . THURSTON-MASON HEALTH DISTRICT N°' G' ••
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Shel��n WA. 9884 4th & r r
Ph n • 426-44 7 DIVISION OF ENVIRONMENTAL HEALTH r Olympia,WA. 98501
���0�p ! / - iyI r't i7 / /)-(..Z.)--- C�4ri c)Pu�a f Phone: 753-8073
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OWNER' S ADDRESS St e / aQ/ r �7 CITY. '/ !�/1/' STATE y1/d S1) O
SEND REPORT TO Ole± O/ L4? t' e /f R CITY///v 1�I STATE Y i a $/} • Cy
SEWAGE CONTRACTOR ADDRESS qZ2 JJ� 3-.J� 1 - c (I- CJ
(If self confer with E.H.S.)
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LEGAL DESCRIPTION �n t, e1 E/k ., i aV _— (
PARCEL NO. LOT SIZE X/33 1,2 INTENDED USE OF BLDG._ O
NO. OF BEDROOMS 2 NO. OF BATHROOMS / /` BASEMENT PLUMBING: Yes_ No >( ' o)
NAME OF WATER SYSTEM Like/ INDIVIDUAL PUBLIC COMMUNITY X
DIRECTIONS TO PROPERTY: (Be Specific) CZ/( s F/) 21 Jo G t T l� � Di
DRAW A SKETCH SHOWING: 1. Property lines, location of house on the lot, and dimensions of the
lot. 2. Location of the house and sewage disposal system in relation to streams, lakes, wells,
soil log holes, patio, driveways, underground tanks, water sup lr. lines'StMtl easements. .
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�`� Alder Street
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ENVIRONMENTAL
HEALTH
The septic system is an approved temporary method of sewage disposal
DO OT WRITE IN THIS SPACE
M IMUMS: 7 /� �,
$epti c Tank l Q L_ C" c Q"��
Drainfield --y Z. 0 I c /1 LL/
SITE APPLICATION
REC: 1VLD
/ APPLICANT'S SIGNATURE DAT r-
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1 i,.'i.'i;
SITE INSPECTION
FEE V. - IPT NO. z�. 7a BY � L
APPROVED 3 J 7 p NOT APPROVED Bd ^`
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Date Date Insito l:'S^.' ^-
J
SEWAGE APPLICATION / / NEW / / ALTERATION ��
/ % / APPLICANT'S SIGNATURE DATE
FEE 19'° RECEIPT NO. 2,z5,13 BY
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Printed.-)rinteci from Mason County DMS 1
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THURSTON-MASON HEALTH DISTRICT
529 W.4TH PHONE 753-8073 - P.O. BOX 746 1 1 O W. "K" ST. PHONE 426-4407
OLYMPLA, WA 98501 SHELTON, WA 98584
RECORD OF FINAL INSPECTION OF YOUR SEWAGE DISPOSAL SYSTEM
OWNER, PARCEL NO
J
.jj. S rG M E /K A N
ADDRESS (1 TOWNSHIP RANGE SEC.
3C6 Si 't 6 4 4:1 �1 e-4 7TLt A.' JAY /GL�
THIS RECORD IS NOT A GUARANTEE OF PERFORMANCE. NAME OF _ LOT
A SEPTIC SYSTEM IS NOT A MUNICIPAL SEWER. HOWEVER PLAT �R,,4,, S ,„Q 4 p ! 4/1 336,1 NO. ''9
WITH PROPER MAINTENANCE AND CAREFUL USE OF SOIL
WATER IT CAN GIVE MANY YEARS OF TROUBLE FREE SER- COMMENTS `LAG, G!CY jai L.
VICE. MANY PROBLEMS WITH SEPTIC TANKS ARE CAUSED SITE AERATION FIELD X
BY FLUSHING EXCESSIVE AMOUNTS OF PAPER, CLOTH NO. L 2 if SIZE
AND PLASTIC MATERIALS DOWN THE DRAIN, OR BY LARGE DEPTH TO MONTH SAND
AMOUNTS OF WATER FROM LEAKY FAUCETS OR FAULTY WATER TABLE OF YEAR 7/U�MMFILL
FIXTURES. INSTALLER /� 1
THE SEPTIC TANK ITSELF SHOULD BE CLEANED EVERY 1 D iCtt b
TWO OR THREE YEARS DEPENDING ON THE HABITS OF THE SIZE
FAMILY, THE NUMBER OF FIXTURES IN THE HOUSE, AND SEPTIC TANK (SI `1 a ' Z. -4 & _ I eo,rP
THE AMOUNT THAT A GARBAGE DISPOSAL IS USED. DRAINFIELD TOTAL FEET
CLEANING AT THE RIGHT TIME WILL AVOID THE RISK OF LENGTH ,Se / . -6
INJURING OR DESTROYING THE DRAINFIELD DUE TO TRENCH AREA TOTAL SQ. FT.
SOLIDS CARRYING OVER INTO THE DRAINFIELD. CALL THE ._3 Z 4, o
THURSTON-MASON HEALTH DISTRICT FOR A LIST OF LIC- TILE CI CORRUGATED SOLID ❑ CEMENT
ENSED SEPTIC TANK CLEANERS IN YOUR AREA. THE CLEAN- DEPTH /�/
ER CAN SERVE YOU BEST IF YOU SHOW HIM THIS RECORD ROCK
WHEN HE COMES. CU. YDS. 2- Z D DEPTH INCHES
HEAVY TRUCKS OR EQUIPMENT SHOULD NEVER BE SPACE RESERVED FOR
DRIVEN OVER THE TANK OR DRAINFIELD. CONSULT THIS REPLACEMENT DISTRIBUTION FIELD: SQ. FT.
RECORD IN CASE ANY BUILDINGS, DRIVEWAYS, SWIM- 4 NORTH
MING POOLS, OR EXTENSIVE GRADING OR FILLING ARE
LATER CONTEMPLATED. .f'
SHRUBS OR TREES SHOULD NOT BE PLANTED CLOSE TO
THE SEPTIC TANK AS THEY WOULD INTERFERE WITH -It 6
CLEANING OF THE TANK. THEY CAN BE PLANTED IN THE ‘ I Rh,tt R
DRAINFIELD AREA PROVIDING WILLOWS ARE NOT USED. M' 4 °
THE YARD GRADE IN THE DISPOSAL AREA SHOULD BE SUCH < <
THAT SURFACE WATER IS NOT POCKETED ON THE DRAIN•
FIELD. ANY SETTLING OF THE GROUND OVER THE TREN-
CHES SHOULD BE FILLED IN WITH SOIL. DO NOT EXCES-
SIVELY WATER THE LAWN IN THE DRAINFIELD AREA. -to _
WATER EVAPORATION FROM THE DRAINFIELD IS ABOUT
EQUAL TO ONE HALF INCH OF RAIN PER DAY.
FOOTING DRAINAGE, DOWNSPOUTS AND WATER
SOFTENER RECHARGE WATER SHOULD NOT BE CONNECTED
INTO THE SEPTIC SYSTEM OR DISCHARGED INTO THE DRAIN-
FIELD AREA.
THE TYPES OF BACTERIA NEEDED IN A SEPTIC TANK ARE
ALWAYS FOUND IN SEWAGE. THERE IS NO NEED TO ADD
YEAST OR OTHER STARTERS TO A SYSTEM. THE USE OF RE.
JUVENATORS OR CHEMICALS TO CLEAN A SEPTIC TANK
HAVE NOT BEEN PROVEN TO BE BENEFICIAL AND MAY
BE HARMFUL BY FLUSHING SOLIDS OUT OF THE TANK OR
BY CHANGING THE CHARACTERISTICS OF THE SOIL. THE SOUTH
NORMAL USE OF BOWL CLEANERS OR CLEANING COM-
POUNDS WILL NOT KILL THE BACTERIAL ACTION OR SLOW ` ( )
DOWN THE OPERATION OF THE SEPTIC TANK. X-14( .1 ladk. l}���t�'\1 -)7
DA 944.-474.-
APPROVED BY
THIS IS AN IMPORTANT DOCUMENT -1-"4"--Z a d
P IT WIT DEED OR OTHER. ACEµ-- CERTIFIED By
printed r`'�`- T n 4. OU ` D� ';,,- / , r
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Printed from Meson County WAS