HomeMy WebLinkAboutSWG94-01993 - SWG Application - 12/13/1994 (2) ON-SITE SEWAGE SYSTEM SITE EV UATION AND DISPOSAL PERMIT
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MASON COUNTY DEPARTMENT OF HEAL SERVICES PERMIT NO. Bill
426 W.CEDAR/P.O. BOX 1666/SHELTON,WA 98584 Date
PHONE(206)427-9670 Receipt No.
Amount$ m E
9 CHECK APPLICABLE ITEMS 3
MhA) V m <
MAILING ADORES DAYTIME PHON •3S INSTALLING NEW SYSTEM V 2
�p REPAIRING OLD SYSTEM
CITY: STATE: IP: EXPANDINGSYSTEM m
2!40KJ Gt1O� SINGLE FAMILY
PROPERTY ADDRESS: OTHER c
y IFC� DIRaCT f F 2Ra LOxC!fA eTMIeNG TE:
PRIVATE WELL $
7.OrA!it F t PUBLIC SYSTEM
SYSTEM ID NUMBER "J
Ri f BW M� tdtleA+ Ra• Mr 'lw SYSTEM NAME
rrX�[�� p APPLICANT ^
e if R&-r6 R ft d 'oe Dr y t . NAME i
ame of Lot a:? /) ft.x�ft. MAILI ADDRESS OK I W
Installer ��"
Size: ..� acres
Name of am r SIGNA fl o
Designer Bedrooms X '
PLOT PLAN PAW
I�
Draw a dimensional M.;l; 0I !1- m —
A
Precise location t
ho I win
a
in is an (� � W(Jel�` I p
pr and O .5
E d:o r
d S.
NO DR N I \
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W
ICIAL USE ONLY. DO NOT WRITE BI 0W DOUBLE LINE.
SOIL LOGS
�-7 l 71- 02-
Ttf3
6-30 .SAA.)ISLcxaa b- 3/ S,CNu Loam+, a -z� Setifl[�w
36 u—)&4-er A,/-Qr
Depth from Original
Grade to Restrictive
Layer or Water Table: Z6 In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REOUIREMENTS
Finding Score Designer Level: ❑One .la Two
Soil Type y 'L
Septic Tank Daily
fi Vertical Separation / n Capacity: 12o V Gal. Flow: .3G U GPD
Slope 2. %
Appl. Infilt.
Parcel Size l•3 Ac. U Rate , L GPD/FT' Area 6 uU FT,
Distance to Shoreline J6 It. IS Total Inspector^ - J Date
U4/Lt 1� —�s -S•f
COMMENTS/CONDITIONS FOR APPROVAL
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 Atesign RequMd ❑NU APPro+ed DESIGN: ❑Approved ONot Approved INSTALLATION:?Approved ❑Not Approved
BY: y� DATE�.2JSS 11 BV: DATE: BY DATE: