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0 • <br />SNOHOMISH <br />HEALTH DISTRICT <br />WWW.SNOHD.ORG Application For An On -Site Sewage System Permit <br />GENERAL APPLICATION INFORMATION__ <br />PROPERTY TAX ACCOU14T #: 280508-004-0.1300 LOT #: <br />Sec: $ Twp 28 Rg: 5 <br />New <br />Ren;;wal Redesign11 Alteration Revision Repair <br />Waiver Request Submitted <br />Applicant Name: Mark Golike <br />-------------- <br />1Mailing Address: 7818 Larimer Rd <br />City: Everett <br />State: WA zip: 98208 <br />Applicant Phone: 425-941-9958 <br />Applicant Email: mark.golike@gmaii.com <br />Installation Address: 7818 Larimer Rd installation City: Everett <br />Water Supply: Individual Well fl— PutAc Name City of Everett <br />j SEWAGE DISPOSAL SYSTEM DESIGN INFORMATION <br />� New ---- <br />Type of Building: Z SFR Duplex �Comrnercial Other Acc Apt # of Bedrooms 3 <br />_ ✓ E=xistin�c <br />Pretreatment Type: SF ❑ ATU EPBF 121 N/A �J Other <br />Dispersal Type: Gravity Z LPD E SSD Mound SL8 <br />®Other <br />Lot Size: 3,14 Acres Operating Capacity: 270 (gallons/day) Design Flow: 360 (gallons/day) <br />% Slope in Drainfield Area: 32 Depth to Water Table/Restrictive Layer: 48+ (inches) Soil Texture Type (1-6): 4 <br />Application Rate: 0.6 (gal/sq ft/day) Absorption Area: 600 (so ft) Installation Depth: 12 -15 (inches) <br />Septic Tank Size: 1000 (gallons) Pump Chamber Size: 1000 -_ (gallons) Date Ws Logged: 3/25/2019 <br />Required Cover Soil: Volume: $0+/- (cubic yards) <br />DESIGNER INFORMATION <br />Designer Name (Printed): Richard 01livier <br />- — <br />Designer Signature. <br />:��j <br />— --- <br />Address; 12702 48th Dr NE, Marysville, WA 98271 <br />License Number: 5100371 <br />Email: roseptic@gmai1.com <br />Phone: 425-377-3660 <br />Fee Simple Owner, Contract Purchaser or Owner's Authorized Agent's <br />Name (Printed): Richard 01 ivler <br />Fee Simple act PupdTaNr or Owner's Authorized Agent's <br />Signature: <br />Designer Comments: <br />HEA TH D S ICT USE ONLY <br />Nff APPLICATION APPROVED E 's "' ^ pate 7 / 2 6 / 15 APPROVAL EXPIRES ON: 7 / 2 6 / 21 <br />Corn ments/Conditions:3-BR Sgg Wild. I3Ritiall Serye 1-BR ADU; 2-BR SFR <br />Served by Existing Sys With No Record of AsBuilt <br />F APPLICATION DISAPPROVED EHS Dde <br />Rev10022018jg <br />Environmental Health Division SRO 013 2 9 6 / ONO 0 0 2 0 4 8 <br />3020 Rucker Avenue, Suite 104 0 Everett, WA 98201-3900 0 fax: 425.339.5254 0 tel: 425.339.5250 <br />