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HomeMy WebLinkAboutSWG Application - 3/19/1997 EM PERMIT MASON COUNTY DEPARTMENT OF HEALTIj.SER*ICES PERMIT NO. SWG a c Data I 426 W. CEDAR/P.O. BOX 16661 SHELTON,WA 98584 ° PHONE (360)427-9670 Rece unt$ipt 0 . 00 z o L - -5-97 CHECK APPLICABLE ITEMS I(/ m o NEW SYSTEM MAILING ADDRESS: _ DAYTIMEPHONE: m; e2 B S• Ow /4✓X 36 0- 6- v 6 REPAIR SYSTEM CITY: STATE:e� ZIP: MAINTENANCE REVIEW BiQ O G/lAR•v 1:✓/T 3( SINGLE FAMILY ✓ PROPERTY ADDRESS: OTHER SPECIFY 3 N•,f, S// A A i PRIVATEWELL o . SP IFIC DI IONS FOR OCATIN SRE: COMMUNITY WEWPUBLIC SYSTEM. t �j SYSTEM WFI p Iw _ S SYSTEM NAME E h, / APPLICANT h_ NAME A F IU Name of Lot o�/� ft.x /3©0 ft. MAILING ADDRESS 07 S• F/e Installer 4,41MY AAOT.A t9. o Size: .s acres ELEPHONE .3 07,6 0 2: Name of Number of SIG RE c N Designer Bedrooms ' PLOT PLAN Draw a dimensional plot plan, j{Q,VP Q J7R' ve",q y IY f including: 1^'AY to ❑Precise location of test ADD 71 He^f F O holes,showing sys7�^ measured distances to Ex:51:n+� `•sfK property boundaries. SYS 7f. a t`ntry road;other roads, C u U U driveways. NOTE: DO NOT DRAW IN MR 1 9 I7JI p SYSTEM DESIGN C �{ OFFICIAL USE ONLY. DO NOT WRITE BEL L !NP/1GES SOIL LOGS DESIGNER DESIGNATION SCORES � MINIMUM SYSTEM REQUIREMENTS Fintling Score Designer Level: 11(One El Two Soil Type 111( ����� Septic Tank ,-v tg�+ Daily Depth in. Soil Capacity: Gv' Gal. Flow: GPD Slope Appl. Infift. Parcel Size Ac. Rate NI* GPD/FT' Area N(LA FT' Distance to Shoreline n. Total In Date r COMMENTS/CONDITIONS FOR APPROVAL 3"( �N�Qod u s. n,t « SLiA )Nn.�+�A-k$PoJA p&11n 4� Iabeel^ Slnq /hnd 4kji .Q�� G.c�F.w�. Ar.:... hiv4il ,, .x-7Ay A GAf pfym JV6 /4.Qhl>7- 7-// S ARAW Ali /,5 SNaw ',vG /A,D,D SeuYR ffYSTewj TO 6A0?A6C' _ASS NPPD A TBi LA! ANC SINK i N 6hd?A6P . 7 #LO Co v%RAtTOA )9>Q G,MAde ,LeP7 'T OU% T Z SA`I e" iT ON OAi6 �R/ LyPAc✓,rv(e _ •All on-site sewage systems must be designed by a Mason County Cemfied Designer or a Professional Engineer. - •All on-sae sewage systems must be installed by a Mason County Certified Installer,unless prior approval is granted for a homeowner installation of a gravity system. In such cases a preliminary on-sae meeting between health department atafr and the homeowner is required. •On-site sewage system design approval does not imply other building site requirements(i.e.RLC,Water Adequacy)have been met. •Any change from the specified use of the property a an sge alteration affecting the system design may invalidate this Pearl. •Ths perm expires 2 years from the date at sae review.Denial of this permit may be appealed to tthhe Health Officer within 10 days of denial date. SITE REVIEW; DESIGN REVIEW:❑Approved ❑Not Approved INSTALLATION:O Approved ❑Not Approve BY: � Q DATE:3�20j- BY: DATE: BY: DATE: I TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM:Applicant's Copy