HomeMy WebLinkAboutSWG Application - 12/29/1975 SITE NO. PARCEL NO.
•THURSTON-MASON HEALTH DISTRICT DATE BASIS FOR FEE AMOUNT RECEIPT
NUMBER
DIVISION OF ENVIRONMENTAL HEALTH
529 WEST FOURTH 110 W.K ST P.O.BOX 746
PHONE 753-8073 PHONE 426-4407
OLYMPIA, WA 98501 SHELTON, WA 98584
OWNER
P o PHONE DIRECTIONS TO SITE: TOTAL
FEES
SEWAGE
CONTRACTOR
ADDRESS OR
LOCATION
NAME OF PLAT LOT
NO.
SOIL TYPE
TOWNSHIP RANGE - SEC.
DEPTH TO WATER TABLE FT.
WATER ❑PUBLIC ❑ PRIVATE
SOURCE PERC. TESTS: INCHES PER HOUR
TYPE OF LOT BY: DATE
BUILDING BASEMENT SIZE X
NO OF NO.OF GARBAGE PRIMARY SECONDARY
GAL.
BEDROOMS BATHS DISPOSAL SEPTIC TANK ICI AERATION GAL.
SPACE RESERVED FOR DISTRIBUTION TILE TOTAL Ai° "VI)/ r/[a FEET
REPLACEMENTS DISTRIBUTION FIELD SQ FT. 5. 4-AnyA t'fi iif rl 1-+t
NORTH - SITE PLAN AND SPECIAL STIPULATIONS: TRENCH BOTTOM AREA �. SQ. FEET
QUANTITY OF
APPROVED STONE CU. YD. SAND CU. YD.
FILL REQUIRED CU. YDS.
THE ELEVATION OF THE BUILDING SEWER SHALL BE SUCH THAT
THE MAXIMUM DEPTH OF THE DISTRIBUTION TILE SHALL BE BE-
TWEEN 12 INCHES AND 36 INCHES FROM FINISHED GRADE TO
TOP OF TILE UNLESS OTHERWISE STIPULATED BY THE HEALTH
OFFICER. IF THE ELEVATION OF THE BUILDING SEWER IS TOO
LOW TO MEET THESE ELEVATIONS,A SEWAGE EJECTOR MAY BE
REQUIRED.
ISOLATION STANDARDS FOR PRIVATE WATER SUPPLIES:
BETWEEN WELL AND TANK OR ANY PART OF THE TILE FIELD,
100 FEET FOR SINGLE RESIDENCE, MOBILE HOMES, DUPLEXES
AND MULTIPLE DWELLINGS. NO DRAINFIELD WITHIN 100 FEET
OF ANY WELL, FRESH WATER LAKE OR STREAM;1 00 FEET FROM
ANY SALT WATER BODY.
NOTE: FOOTING DRAINAGE, DOWNSPOUTS, WATER SOFTENER AND ANY
OTHER WASTE WATER NOT DEFINED AS SEWAGE SHALL NOT BE CONNECTED
TO OR DISCHARGED INTO THE SEPTIC TANK SYSTEM OR THE SEWAGE DISPOSAL
AREA'. ALL SEWAGE, INCLUDING SINK AND LAUNDRY WASTE, MUST BE
CONNECTED TO THE SEPTIC TANK
FINAL INSPECTION REQUIRED BEFORE BACKFILLING
OFFICE USE ONLY / TO BE BACKFILLED • •
DALE APPLICANT MUST CALL FOR INSPECTIONS LISTED BELOW AFTER INSPECTION
12" TO 24"
SITE: A APPROVED ❑ APPPPROVED NOT
2" STRAW
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as J
C WrI`ts �•L:,S���$k•'r''=.. .:S1iy; STONE
SEWAGE: ❑ APPROVED ❑ NbT 40 �`igl" ; ' `;i��A' OVER TILE
APPROVED �„:"•� •: O,/(�i.••
BY 40,11tibViail0;�` lipi•tj j :4 Feto I I STONE
NOT BY: ! FS�S a t'.,4_4;!� 0 IV-, UNDER TILE
WATER: ❑ APPROVED ❑APPROVED
IF I > I J"
,3a�3 �• f 3• oo150
CROSS SECTION OF TRENCH