HomeMy WebLinkAboutSWG94-00981 - SWG Application - 8/4/1994 - .'r" 5 ' PER IT NO^'1'` WG;; C '
`` MASON COUNT/DEPARTMENTOFH VICE i
-"�''' 426.W.CEDAR/P.O .$O)C1666 S 1ELTON;'WA 98584 Date-' t I. 1 9t D ; o' Y
Receipt No.
' '^ t PHONE(206)427-9670 -• if.Amount$ z z
• PROPE OWNR'. DATE:
r, AAA� 2 • 2-
CHECK-APPLICABLE ITEMS -'V:, a);
I. INSTAWNG NEW SYSTEM P.
r•MAI}I�IG ADDRESS: ` �t", - DAYTIME PHONE:, j_ REPAIRING OLD SYSTEM �
• \_ ... \ GX -1 ye• ,C.`�� t S EXPANDING SYSTEM
CITY. \1 STATE: IP:
lc ,�r y>,'� SINGLE FAMILY t
PROPERTY ADDRESS: + OTHER - PI C'I.�'S z
;,,. .z_ — �7�,�.\v1 1s �J� SPECIFY: 3
':SPECIFIC DpECTIONS FOR LOCATING SIT PRIVATE WELL g
�- l 1 ` PUBLIC SYSTEM - Nc,,,,
�C ,, � ,\\-..r. 1�t .�-{ P�'�' Cry 1�Ir'1 Ic1� SYSTEM ID NUMBER .
rt. \ - e N‘-' V�',, ` : \ 1Ca CY•,c' or \ S (\Cr ` (' APPLSTEM ANT ME I�
_ • NAME )r� �f\� (U �:
Nameof x ft. MAILING ADDRESS \'.fi \ x,,`•�
i Lot ft.
`; Installer .�t� -\c'\-kr.1.: \',AN, �1j").7.)44 v .
Size: 1 acres' TELEPHONE--O O(-, I y `IS 5: L-
Name SIG URE -f \ E. 0-
''T''" Number of ` G „ W,
Designer \e \r"� p� Bedrooms \ y d X`�`' -_.,C \_ ,(`' ,r'\ vA d, .
PLOT PLAN Y . J
Draw a dimensional plot plan, `''" .:.x .. , '
. including: g
t'O Preolse location of test . _ :-f l'
holes,showing -.._ hl
measured distances to I
property boundaries.
n i
4O Entry road;other roads,
driveways. ,--.-
•'NOTE: DO NOT DRAIN IN .. . . '' .-t I
`•. SYSTEM,DESIGN •
Si,
,: .» :. - OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE. '.
s / - --it
J . SOIL LOGS %�3
'. S A n -__:, . , p _4r.:.2..._.54 ..,Q ._.... . 65 7.2 754 10404 iv,
r ZZ:-. -- r s4trii �r,�,,,f Z -7 )Z. IX/,�-t�'r. 21 bb So.�r�GY,;,�( T�,� L
-S`7 T -t
/,'� G,—,_ c . - O„,2 5"54,44.4 M s - -- -
,?S'-b7 S4n.f.I&ra..e( ,
,� .__ .(Twe-II_...., _.: _ .:Depth from Original,--
. . Grade to Restrictive .:
' Layer or Water Table: XZ In. `
DESIGNER DESIGNATIONSCORES . , MINIMUM SYSTEM REQUIREMENTS
_ _
tFinding Score Designer Level: ❑One `�Two ,
Soil Type . ..:... -• ' . L
Vertical• Separation win. /S Septic Tank Daily
�•,,,, Capacity:346 o Gal. • Fl9uy:,, .yy0 GPD
l Slope %• Appl, "Infllf .
Parcel Size i 'T 'Aa S Rate 1 16. GPD/FT2 Area-13 y" FT2
rtce to Shoreline : it. S Total /' Inspector Date
, "" ";'' °`'�� COMMENTS/CONDITIONS_F.OR.APPROVAL':"��
Mgr,,ice „ �"�}�, f!f -' _--_ ,.kit lia5.4*W O ti'aI'AIVW : . \ •
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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 ,
r1 is Permit expires years from date of site Inspection,Denial of this permit may be appealed to the Health Officer within 10 days of denial date. .
StTerAwrove4 t1Desfgn Required ❑Not Approved DESI N: Approved O Not proved;; INSTALLATION:O Approved ❑Not Approved 1
` BY :i\,U�'• -6-; _DATE:if/( y'/ BY L , ,,T. "DA t .144.4 DATE:
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:h TOP: Health Dep Oo� MIDDLE:Des ner's copy'.BO'11 M Applicants..COPY
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