HomeMy WebLinkAboutSWG93-0582 - SWG Application - 4/25/1996 ON-SITE SEWAGE SYSTEM SITE EVALUATION AND DISPOSAL PERMIT
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MASON COUNTY D M !'
DEPARTMENT OF HEALTH SERVICES PERMIT NO. t _ "? - illo. w D
SITE LUATI DESIGN AND INSTALLATION cr
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426 W. CEDAR/ P.O. BOX 1666/SHELTON, WA 98584 Dat a -7--) Date < N
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PHONE (206) 427-9670 Receipt No. Receipt No. o 0
Amount$ Amount$ z
PROPERTY OWNER: DATE: a' m
2/4 A/ .2). V(� 5/.7/9 3 CHECK APPLICABLE ITEMS `/ CD m
MAILING ADDRESS: �p DAYTIME PHONE: INSTALLING NEW SYSTEM ✓
/Sc 3 L 3•7,4v. /VCSez-'/ Wig. f/S-5- 632-000 REPAIRING OLD SYSTEM `�
CITY: jz}pri_ STATE: ZIP: - EXPANDING SYSTEM
W/4 . cighcr SINGLE FAMILY ✓
PROPERTY ADDRESS: OTHER ` z
iatiVect0 //C7 3/ /Vrz,14 S/'Z9 -e i, SPECIFY: -I' 3
SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL
-45 -i ,/�Jt��/ /1 �2 , dA N�IK PUBLIC SYSTEM ,�
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54///,�,�� // / n / SYSTEM ID NUMBER N1•'
L2 A!'t- *Farr( C —&lc-L i- SGtele -L!ilde.tr SYSTEM NAME Ati
w` e�! APPLICANTFf- �/"
NAME �4-/L/ �. ✓!A. `4 IP
Name of � B rft. xMAILING ADDRESS /SO3L ?i7A J'
Installer k- Lot /�p 3Q� ft. 4�/S S - I�J
Size: 3S S 3S" faeces V F.TELEPHONE ( ZQE )63 2-69Q 0 <
Name of Number of SIGNATU o
g ' O L ��j T.C)
Designer Bedrooms . x 4,
PLOT PLAN At''l !.014-0.4.., / 8. *5-
F.)
Draw a dimensional plot plan, ^ —Al—di S/ ' N
including: m
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CI Precise to test LL1 49' 9-
holes,sho� U I
measured ceA V
property brrie m r I� 3�r Gb IC)r V r
Entry road;-b' r ro LU gV4
driveways: rJ] C/) _MA/ VGC
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NOTE: DC �DR IN I //D A'X/i/. "te 4(. ''
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SYSTiI DEN '
Al, Sly-ze_ exr,? 0, ,-) 1
OFFICtAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
SOIL LOGS
c_ 1A-6 en 30,40 Sul 7, Gqclize;
.l 0- Pit Co/mt .52nd,, ,g'L) r ) ) l `b Trin e letpzsdi7e)
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,, Hi rA�- ( j s / o r� cl oOw� tg
TlA 0� 1 1.07m _5pn4A. fl77i roes w_t/q, 1 om� gan4CUl? n5
&N°-)s• �C C Con? C `k 100A, C�z°/I1ee ' cl eT sm ll�rmeis
V 'I Depth from Original
{n_ C� �'�,j7 Znite,„'1 tOi t n,i� e' tilt
,t, Grade to Restrictive
''O "e`, J 41,,,ii FII 1?1 � 21A 5 (�PT7/, 6,11,, A04 Layer or Water Table: In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Finding Score : Designer Level: O One Two
Soil Type 3 6
Vertical Separation \3 Septic Tanl4 Q Capacity: 00
Gal. Daily
,y v y GPD
Slope J e Appl. Infilt.
Parcel Size e 1 Rate () r g GPD/FT2 Area y7o FT2
Distance to Shoreline Total ` f Inspect r Date 3/77/,3
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COMMENTS/CONDITIONS FOR APPROVAL
Due 4o cl-Oure
io 11 Iti � bU1/ Ier5 927d 72/77,1f .P/ir?
id t tY'Z L�� l , �� Lt to L 1 er7 16 2 z 2�'1 ils,('
/6-9-
40 brr ne smiJ up a /9iiz )
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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 his permit may be appealed to the Health Officer within 10 days of denial date.
SITE:. Tripeesesign Required �I Not proved DE N: roved Not Voved INS. L T pproved U Not Ap rove
BY: DATES 7 p BY: 1 Vi aN'UATE: l�?.3 BY: ,�(�} DATE: J 4