HomeMy WebLinkAboutSWG94-00982 - SWG Application - 8/4/1994 . ...�.�., <_.:.: ;;.� PERMIT NO. SWG ,.. -� � 0 �'-� cn A
MA N•COUN 'Y-DEIrARTMENT OF HEALTI�SE' If✓ES"" g N
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4 ; Date ,o� ci . o. o
426 W.CEDAR/P.O. BOX 1666/SHELTON,WA 98584
' - ` PHONE(206) 427-9670 A oulnt pt$o / G
PROPERTY NER; DATE: W < -;
`� ` CHECK APPLICABLE ITEMS
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MAI.�K G ADDR S: ` , , 4AYTI E P Q INSTALLING NEW SYSTEM l�
r� \ k �� ` 1� � `� REPAIRING OLD SYSTEM
CITY' STATE: d ZIP: EXPANDING SYSTEM w
•"\ c.)1.\ \,)Il °V> )5L' SINGLE FA ILY - / g •
PROPERTY ADDRESS: ` OTHER 5 `)'J ✓ z
l _1-` -Y'Y'y \ - /� 7)r , SPECIFY: 3
SPECIFIC DIRECTIONS FOR LOCATING SIT PRIVATE WELL $
V( •.,-•\ •.r,\\..- -N1 ,r�✓ , ec \ Gr �,lc r\ PUBLIC SYSTEM - 1\°k.J
_ \�j SYSTEM ID NUMBER Ii-�
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\�'e_ , •>�.:\' �Y' LS(r�,.:N�,-„r Gr 1e1 \- ```c,rYY1 APPLICANT
NAMESYSTEM ��
-�n(" NAME \)(•-•\/' �C. , �.` p
Name of Lot ft.x ft. MAILING ADDRESS\• .() \ ,. 1)5
Installer -.\-,-\\ors,.t i.)k� ''`� - 1
Size: �-,.`�� acres ti
TELEPHONE ( c� ?�'�l �`��� j 5 I�-
Name of SIGNAIURF ' f
• Designer � � Numbers `cI G y� , . /� .
P \O, Bedrooms 6 X �--- a.� .,(. . I L
PLOT PLAN =y..-s -,` , �\1C' �� \,1 �
7
Draw a dimensional plot plan,
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including: 00
0 Precise location of test ,
holes,showing `�\ � �l 1 P
measured distances to `�
property boundaries. I`-'
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❑Entry road;other roads, fa. h)
driveways. ;
NOTE: DO NOT DRAW IN k,
• SYSTEM DESIGN
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OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
S- 6 SOIL LOGS 'w" . .
. U - i0 5P an G�,�
O'.?c. S t•c.c,.n. C,S— V SRriv,(4(�n� O ' S/Vhd J <n,
✓-• 2 S t),otfll.'] u t 2S, sur`cF4Cr.,,x' .26 -s`1 (T•�±G,,,vef / 7•5 t% SAnd 6,vae � - % S�a)ld (7�r., ,�
2V 3 -..t6,c�iGruvcl Yr +.) s_y,&�, (Tv',z) b � /.ryi3 2)
ern
Depth from Original
Layer or Water Table: /0 In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
' Finding Score Designer Level: D One gr Two
Soil Type K 2
Septic Tank Daily
Vertical Separation ,) in. // Capacity:366 p' Gal. Flow: /`/yam GPD
Sl pe . . Appl. Infilt. ....
Parcel 6-e' ' 6.7`� Ae. • • S'' Rate , k, GPD/FT2 Area-2 Y' FT2 .
Distance to Shoreline 1(54 ft. 15 [Total 1 /2 Inspector / ( Date `0 -i4
COMMENTS/CONDITIONS FOR APPROVAL
III/1 SY.S*,,, /5 cif c o f c,..c r Lccu rr.y o /-11/.74(Cc( oro f g -to-9 ,1 /
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M
air Anychange 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 this permit may be appealed to the Health Officer within 10 days of denial date.
SITEl: Approved;IQ Design Required .0 Not Approved DESIGN: Approved 0 Not Approved INSTALLATION:O Approved 0 Not Approved
• BY• DATE:a-i,.y., BY DATE:f/C Sq BY . DATE:
TOP_,Health De t Cp.y MIDDL : Designer;s Copy BOTTOM Applicar�Cs Copy u�
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