HomeMy WebLinkAboutSWG92-0741 - SWG Inspections - 10/7/1992 M�4s6h OUNTY PARTMENT OF HEALTH SERVICES r RMIT NO. rjC-D
SITE EVAt. AT1 I DESii�N A D INSTAL TION—i DateDate
�26 W.QEDAR/P.O. BOX 186/SHELTON,WA 98584 Receipt No. (e Receipt No.
;,RHONE (206) 427-9670 � • Amount$ Amount$� z V
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P DATE: CHECK APPLICABLE ITEMS ✓ m m
M L DAYTIME PHONE
INSTALLING NEW SYSTEM
, t 51 REPAIRING OLD SYSTEM
. I tX ,. EXPANDING SYSTEMa w.>
y y«. . ,. R SINGLE FAMILY -t
PR PER ADDRESS OTHER Z c
r.
•, SPECIFY: B
SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL m
PUBLIC SYSTEM
CorrectionTake Dayton Airp-art Rd. � mile past SYSTEM ID NUMBER A
Center--Turn Right--turn left at top of hill, Go SYSTEM NAME k
APPLICANT
past 2nd. Cul -De—Sac--second lot past Cul—De—Sac NAME h�
Name of Lot 330 1 ft.x 3_3 0 r n, MAILING ADDRESS
v,
Installer
Size: 2. 5 _acres TELEPHONE
Name of um er o SIGNATURE
Designer Bedrooms 3
PLOT PLAN
Draw a dimensional plot plan,
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including: o
x
U Precise location of test T4 '1" +
holes,•showing 'k-- 4 w�-3
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measured distances to ,3p Q )
property boundaries. ,
❑Entry road;other roads,
driveways. I
NOTE: DO NOT DRAW IN
SYSTEM DESIGN
33I,a i
OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
SOIL LOG
�'o� 9S�-fO �1 � am s
l! a CA
Depth from Original
?� - Grade to Restrictive
Layer or Water Table: _
'-'DESIGNER DESICINATION SCORES MINIMUM SYSTEM REQUIREMENTS
r Design:*evel One U Level Two
Soil
Vertical Separation 3 Septic Tank Daily
` p /Capacity: ! r_ !. F!ww: MI6 0 GPD
�'. Slope. 0 ��U C-
ep
Appl. J�y Infilt. Depth-from Original
Parcel Size 0 T C3 GPD/FT2 Area ��a FT2 Grade to Bottom of
Rate Absorption area: I
Distance to Shoreline Total Inspector Date
COMMENTS/CONDITIONS FOR APPROVAL
❑Owner/Designer/Installer must meet on site to verify precise system layout ❑Owner must arrange pre-installation conferences with health dept.staff
❑Winter observations required 0 Extreme care needed during site preparation to preserve existing topsoil
Any change from the specified use of the property or any site alteration affecting the system design may invalidate this permit.
This Permifexpires 3 years from date of issue.Denial of this permit may be appealed to the Health Officer within 10 days of denial date
SITE:Aj
Approved Required ❑Not Approved DESIGN: U Approved U Not Approved INSTALLATION:U Approved 0 Not Approv
BY: DATE./V-4,q BY: DATE: BY: DATE:
TOP: Health Dept Copy MIDDLE: Designer's Cop BOTTOM;Applicant's Cop