HomeMy WebLinkAboutSWG Application / As-Built - 6/13/1980 SITE NO. ar Ish
MASON COUNTY HEALTH DEPARTMENT FOR DEPARTMENT USE ONLY
-- ENVIRONMENTAL HEALTH SECTION DATE BASIS FOR rit - AMOUNT RECEIPr
428 WEST BIRCH STREET • SHELTON, WA. 98584 ._ NUMBER
PHONE (206) 426-5561 - -
APPUCANT SIGNATURE
—
ADDRESS PHONE
SITE: � APPROVED O
APPROVED
PROPERTY OWNER
BY.
ADDRESS PHONE
DESIGNED SYSTEM REQUIRED
SEWAGE SEWAGE NOT
CONTRACTOR DESIGNER SEWAGE: ❑ APPROVED ❑ APPROVED
HGAI DESCRIPTION
BY.
SOIL TYPE
TYPE OF NO. OF LOT
BUILDING BEDROOMS 5 SIZE_X ; DEPTH TO WATER TABLE PERC. RATE
SINGLE FAMILY ❑ PUBLIC WATER ❑ NAME SEPTIC TANKS GAL. PUMP REQ.
WATER SYSTEM SYSTEM ( )
COMMERCIAL ONLY
LIQUID WASTE G.P.D. DISTRIBUTION TILE TOTAL FEET
DIRECTIONS TO SITE: FILTRATION AREA SQ. FEET
QUANTITY OF
APPROVED STONE CU, YD. SAND _—CU. YD.
FILL REQUIRED—CU. YDS.
FINAL INSPECTION REQUIRED BEFORE BACKFILLING
DEPTH OF
BACKFILL
2"STRAW OR PAPER
E C�STONE
_ 1b OVER TILE
F�PIPE SIZE
F�STONE
SITE PLAN AND SPECIAL STIPULATIONS UNDER TILE
(INDICATE DIRECTION OF DRAINAGE) CRC55 SEalory of TRENCH
n
COMMENTS:
THIS SITE PERMIT EXPIRES
O-
MASON COUNTY HEALTH DEPARTMENT SEWAGE SYSTEM DESIGN
ENVIRONMENTAL HEALTH SECTION E DEPTH OF
• 3034JORTH 4th STREET • SHELTON, WA 98584 �BACRFILL
PHONE (206) 426-5561 2^STRAW OR PAPER
PROPERTY OWNER DATE SUBMITTED
F�STONE
ADDRESS DESIGNED 6Y l OVER TILE
F�PIK SIZE
SOIL LOG— DATA
LEGAL DESCRIPTION EO STONE
UNDER TILE
CROSS SECTION OF TRENCH W<-�Re"If"i ve
We,
CALCULATIONS: GPD if other SHOW THE FOLLOWING ITEMS IN GRID BELOW:
No.Bedrooms than residence A. Horizontal system plan and, if mound system is proposed or
slopes exceeding 15%provide cross section.
Application Rate:gal./sg.ft./day B. Scale
Dmintield Sizing:Absorption Area Ftz Total Length Ft. C. Benchmark A,stubout elevation, tank carat elevation, (bot-
tom of pipe),elevation at finish grade at center of dreinfield.
Pure Specifications: High level alarm Elevation Difference Ft. D. Property lines,building,trees,slopes in excess of 5%,driveway.
GPM Discharge Volu me E. All wel is or drinki ng water appl lea within 1 SO ft.,water lines.
Volume of sump F. Drainage system detail (i.e.curtain drain).
Septic Tank Size and Manufacturer G. Replacement area.
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NOTARY PUBLIC
agree not to hold the Health Department responsible in
the event that the special system as proposed by
fails to operate as required by Articles VI and VII, of the Mason County Health Department Code.
Signature
Subscribed and sworn before me this day Notary Public for the State of Washington
at , 19_. residing at
AIM®ASSOCIATES—OlvmPla,WA