HomeMy WebLinkAboutswg97-0230 - SWG Application - 4/24/1997 7,777N7'E SIVLciE °ATE EVALUA7' 1 -
PERMIT NO. SWG
MASON-COUNTY DEPARTMENT OF HEALTH SERVICES L� G Date 1 �I
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426 W. CEDAR/P.O. BOX 1666/SHELTON, WA 98584 g
PHONE (360)427-9670 Receipt No. a y
Amount$ 7l0 z E
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j- AUS " H �7_ CHECK APPLICABLE ITEMS
MAILING ADDRESS: DAYTIME PHONE: NEW SYSTEM Xo
Z28_ r�Z REPAIRSYSTEM A a
CITY: TE: - ZIP: MAINTENANCE REVIEW m
SINGLE FAMILY X
on $
PROPERTY—ADDRESS: OTHER L z
SPECIFY: 3
SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL X r< $
Fe614 rAAI e B/zt wi✓4 AV. ,<LPi en/LK . COMMUNITY WELUPUBLIC SYSTEM
SYSTEM WFI#
,QT SYSTEM NAME
APP
nd 4i 1"d 14/ d oee ° J old . '%� /o :t AMEL AFY Seh UGT a W
me of MAILING ADDRESS/9dl S. io o JP.
faller .�O Lot '/6dX //° k. x k.
�' l�GAIIZ. _O Size: acres Su; o xx -4i
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me^` um ero SIGNAE o "C
9 Bedrooms x r
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LANimension of plan, eA'� xo`V2 T0 tion D3yest�n9 sbet �A �A a
sur istan to properly -3 Aprt •s may '
pra enyQlOunda VVVJJJ 0
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other ads, oh
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fl..v DO NOT D IN cw'
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OFFICIAL USEmE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
2— 43 SOIL LOGS � b
Depth from Original
Grade to Restrictive
Layer or Water Table: In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REOUIREMENTS
Finding S^re Designer Level: ❑One XTwo
Soil Type
Septic Tank Daily
Slop^_ 2 in. Capacity:/,g0(j Gal. Row: 3(d GPD
j(a-o x Al Infilt.
Parcel Size .f ./ Ac. Rate GPD/FT' Area 6O6' FT•
Distance to Shoreli�e�ILn- ft -.�_. Total Inspector - Date
COMMENTS/OONDITI N OR APPROVAL 1 /
9- 4--�y /&-oyy--(e VAU Gc,&j9-C—a
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7- A �a L�Z Lo' K4 a4,-n,-LJ • / Atto
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•All septic sys ms must be designed and insta ed by contractors certified by Mason Co y Department of Health Services,unless prior aP
granted by the department,or the design is by a professional engineer.
•Septic permit 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 or any site alteration affecting the system design may invalidate this permit.
•This permit expires 2 years from the date of she review.Denial of this permit may be appealed to the Health Officer within 10 days of d,
SITEER - - DESIGN REVIEW:U Approved - Not Approved INSTALLATIONS Approved
BY La�2 ✓v�4'-0.DATE:6--717 BY: DATE: BY: