HomeMy WebLinkAboutSWG2000-00059 - SWG Application - 3/8/2003 MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG — c
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426 W.CEDAR/P.O. BOX 1666 ifSHELTON,WA 98584 Date2.as: o
PHONE(360) 427-9670 Amo, $o' ' Z y
PR PERTY OWNER: DATE: 3
CHECK APPLICABLE ITEMS m
MAILING ADDRESS: DAYTIME PHONE: NEW SYSTEM x R
4215 Kellum Ranch Ed. NW REPPIRSYSTEM s
CITY: STATE: ZIP: TABLE B REPAIR
Bremerton WA 98312 MAINTENANCE RENEW g
PROPERTY ADDRESS: SINGLE FAMILY X z
OTHER: 3
SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL g
COMMUNITY WEUJPUBLIC SYSTEM
on the Bear Creek Dewatto Road, turn left on to SYSTEM NAM N
SYSTEM NAME I N
to the end of the road. Follow the ribbons. APPLICANT
NAME ganno, w
Nameof Lot affaI1Lp{pd fl. MAIUNGADDRESS same
Installer unknown ,s
Size: S_ 17 acres TELEPHONE
Name of Bud Jones um ro - 51 A E �' O
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Designer Bedrooms
OFFICIAL USE ONLY BELOW THIS LINE 1-4
DEPARTMENTAL SOIL LOGS DEPARTMENTAL COMMENTS/CONDITIONS Jim
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SOIL TEXTURE CODES:
V=Very G=gravelly S=sand L=loam Si=silt C=clay E=Extremely
INSPECTOji(pri name) SPEFTIC SI NATURE ATE PERMIT EXPI TION DATE
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•All systems require ongoing Operation and Maintenanc (OLM)as specified in n County n-Site standards.
All on-site sewage systems must be designed by a Mason County Cedgietl Desi ner or a Professional Engineer,unless prior approval is granted otherwi�g
•All on-site sewage systems must be installed by a Mason County Certified Installer,unless prior approval is granted otherwise.In such cases a preliminay orvsile
meeting between headh department staff and the homeowner is required.
•On-site sewage system design approval does not imply other building site requirements(i.e.RLC,Water Adequai have been met.
•Any change from the specified use of the property or any site alteration affecting the system design may invaidate this permit.
•This ¢ "es 3 ears from Me date of sme review.Dena)of this ermit may be eared to the Heath Officer within 10daysof denial date.
DESIGN REVIEW APPROVAL BY: DATE: INSTALLATION APPROVED BY: DATE:
TOP: Health Dept. Copy MIDDLE: Designer's Copy BOTTOM: Applicant's Copy