HomeMy WebLinkAboutSWG Application / Design - 2/28/1980 . ___I'ur,••••180.••••°•••••'""_..........„.......____.,........_.•._,........,
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NUMBER
• 42. WES BIRCH gTREET •'SHELTON, WA. 98584 • ,,•
ir ..., PHONE (206) 426-5561 . .g-I*0 . /4;14-
APPLICAN N-A----RE
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ADDRE PHONE , NOT
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PROPERTY OWNER • 4/-IS-83 BY: , .
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ADDRESS r; PHONE •
. :7-F., C. 4. i il Z.f•• r tOt.', - I 34- / DESIGNED SYSTEM REQUIRED .
SEWAGE SEWAGE '' 7 "N.'''I 7
OONTRACTOR • • DESIGNER
SEWAGE y-
APPROViD C
LEGAL DEWNVI/V X t A—PPR—
OVED
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TYPE'Of NO.Of 1.0T
BEDROOMS )4r.3. SIZE X DEPTH TO WATER TABLE PERC. RATE
BUILDI ...
SINGLE FAMILY IV . PUBLIC,WATER 0
WATER SYSTEM ri.Ink. SYSTEM NAME. . i- , SEPTIC TANK(S) . PUMP REQ GAL.
COMMERCIAL ONLY
LIQUID WASTE G.P.D._ _ _ . DISTRIBUTION TILE TOTAL_ 1$-° FEET
I C
DIRECTIOfs/S TO SITE: FILTRATION AREA . SQ. FEET
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... QUANTITY OF
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N. 1:•••,•^"*- i• :--I APPROVED STONE CU YD. SAND Cu. YD.
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•-•''.7.1'k ,-1-. ,, ,.i„ r,./ .,, , '.- FILL REQUIRED Cu YDS.
, • FINAL INSPECTION REQUIRED BEFORE BACKFIWNG
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1 ' 7 SITE PLAN AND SPECIAL STIPULATIONS I< grAill ) 1 UNDER TILE
(INDICATE DIRECTION OF DRAINAGE) CROSS SECTION OF TRENCH
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COh(MENTS:
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• ... THIS SITE PERMIT EXPIRES
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`. a MASON COUNTY < «:, , . A - - _
• ` DEPARTMENT of GNAW SERVICES
Courthouse Bldg.3, 426 W.Cedar
. . P.O. Box 186,Shelton,Washington 98584 -5 j (�j I_ t
(206)427-9670 J / 4
building environmental health maintenance parks&recreation planning sewer be water ,
WATER SUPPLY $40.00 SEWAGE SYSTEM $50.00
1) Private Wells 1) 11 system on record
Water Sample taken by health official; inspection of Tank pumped; receipt obtained and submitted with
facilities application, then call for inspection
2) Community water system 2) If no system on record
If on an approved community system, no inspection Tank pumped, receipt obtained, submitted with
or sample Is necessary. However, approval is application, portion of drainfield lines exposed to
subject to adequate sample history verify size and existence of drainfield
Checks Payable to:
WATER & SEWA .00 J Mason County Treasurer
APPLICATION FORREPORT ON INDIVIDUAL SEWAGE DISPOSAL SYSTEM AND/OR WATER SUPPLY
It is the established practice of many lending institutions to obtain Information from the local health department
pertaining to the acceptability of the individual sewage disposal systems and/or water supplies.
INFORMATION REQUESTED ON: t 1NDIVIDUAL SEWAGE SYSTEM P/ WATER SUPPLY /gam_ 7
Located at: o e -n \ UA StreetC CitI Zip
r►Oth P Number �, (�
Directions to Property: 5 ��, �
S{vxt1� b� �/ ,/
i
Legal Description: O ! e VCf C 5,�f` _
-t.�Q A♦2 p -4 1Y1/Z/ c2 i /La-- YearHome Built: !7 7� t
Owner or Builder. .�! 7
Purchaser. tj,1�� _Number of Bedrooms: .7' f
�w i' • k- C. & -� l ��
Send Report to: Name ! 0- rk AlOR
t;'.,� -.: ., -i.z•:f1" - S� I-e ' � - 98701"
IOW
•re- • CityZip
A••re:
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Signature of plicant: Phone: y �—b. 7)
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FOR �— DEPARTMENT USE ONLY ,,rram� ."/4' 1�D
/ f— ., ) FEE �•`,•. .y r` RECEIPT #
DATE I�.
SEWAGE DISf OSAt 9VSTEM r Date—Site Inspection �/ - /5" ' g.3
24 House Occupied. ❑ House Vacant Date—Final Inspection $ ! y ? ' P3 -
it is the opinion of this health department that this individual sewage system is functioning
satisfactorily at the time of inspection.
Sewage was discharging on the surface of the ground.
There are indications that this system may malfunction at times.
There is indication of malfunction on nearby properties.
Other.
WATER SUPPLY: •
The supply does conform with drinking standards of this department.
• Remarks:
rI. ,_ , - Date I
'r rf-IrrsInl VifiSOrt( r3fS•
•
t
PARCEL 1:
THE WEST 209.74 FEET OF THE EAST 350 FEET OF THE NORTH 208.74 FEET OF
THE SOUTHWEST QUARTER OF THE SOUTHEAST QUARTER OF THE SOUTHWEST QUARTER,
IN SECTION 36, TOWNSHIP 19 NORTH, RANGE 5 WEST, W.M., MASON COUNTY,
WASHINGTON.
PARCEL 2:
TOGETHER WITH AN EASEMENT FOR INGRESS AND EGRESS OVER THE NORTH 30 FEET
OF THE SOUTHWEST QUARTER OF THE SOUTHEAST QUARTER OF THE SOUTHWEST
QUARTER OF SECTION 36, TOWNSHIP 19 NORTH, RANGE 5 WEST, W.M., MASON
j COUNTY, WASHINGTON, LYING WEST OF THE FOLLOWING DESCRIBED:
THE WEST 208.74 FEET OF THE EAST 350 FEET OF THE NORTH 208.74 FEET OF
THE SOUTHWEST QUARTER OF THE SOUTHEAST QUARTER OF THE SOUTHWEST QUARTER,
IN SECTION 36, TOWNSHIP 19 NORTH, RANGE 5 WEST, M.N., IN MASON COUNTY,
WASHINGTON.
�rme `nu •
F � Ma yDS prif‘troti ir:t,*muss ��€tr!:`e L MS
5 --tq --.3to- 3 - Li a // A,,:, i/.4 -Q-,1--1 2/7 ti
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5th & Birch Thurstoh-Mason Health District Nd. 1.-049 1Covrthcuse Annex
r Shelton, Washington DIVISION Of IN VIION M INT AI lIALtH 19 Olympia, Washington
Phone: 2�-4407 � 3Ya� �� t-hone: 352-4851 .
• 3
�p 3/�40 f SEWAGE APPLICATION n Date
SITE APPLICATION77 lam- Date -�-�' / `� G
Owner 1��C.i"},Cis. ig-11/!i /1'4 Phone yI, •?SY
Mailing Address fie X /(a l/ City A/- C./e4Ry State WA SA
Builder Ri X R eSi 2 Address N`C�/PyRy / /1"(1/.
Sewage Contractor Address
Se /i ar SGV'/y of _SGC. -36 �/y fii SW
Legal Description f f
Parcel No. Lot Size A Intended use of Buildings_
Directions to Property
!"1 LEA7 - 1.� „X N't , b 90i Rt•i/ H1. Mo °1J y 4n '
2t. -ro Tv /0,4. bit,/
No. of Bedrooms ! No. of Bathrooms a Basement //O Water System: PUBLIC
PRIVATE L.—
DRAW SKETCH in blank space:
1. Property lines and location of house on lot and dimensions of lot.
2. Location of house and sewage dispcsal system in relation t streams, lakes, wells,
patios, _ ., underground tanks, water supply lines and easements.
3. Propose" . eluding depth, area, porosity and amount plus location of drains.
I-- zVZ DRATEFIELD LENGTH
Z•.,, SEPTIC TANK SIZE IO 6 4/,
zj •
/ 3
s
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The septic system is an approved temporary method of sewage disposal until
sanitary sewers are available.
•
SITE APPLICATION Qpi.rtitAAJ,
? DATE .�/� a ��
APPLICANT'S SIGNATURE
Site inspection fe /D -- Receipt No. BY
Approved I�2RKCA ��Ili�� Not Approved By Saurian i'1' +
Date Date
SEWAGE APPLICATION New .., a, Alter n DATE �'� �' 1/
APP .ICANF`S SIGNATURE
�, I ; Fed ,-�.,Ci -- 1i,ecsi t 4r,t -iy
f Q 1
Peat t No -- � •.t� F Y By 1
r. xr_.:. . e Sanitarian
414141184414114.1111111.116911,
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Printed From Mason County DMS
Printed fcflco Mason Counter OMS