HomeMy WebLinkAboutSWG2022-00299 - SWG Application / Design - 5/20/2022 415 N 6TH STREET,SHELTON,WA 98584
foillir.,\ xS,�ONCT7aUNTY
�7�7�r�-+ SHELTON:360-427-9670,EXT 400
P-' COMMUNITY SERVICES ICES BELFAIR:360-275-4467,EXT 400
�/ ELMA:360-482-5269,EXT 400
a Building,Planning,Environmental Heal th,Community Health
relt,�- FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2022-00299
APPLICANT BRIDGES JIM L & DARCEL R Phone:
Address: 21003 117th STREET E BONNEY LAKE, WA 98391
OWNER BRIDGES JIM L & DARCEL R Phone:
Address: 21003 117th STREET E BONNEY LAKE, WA 98391
SEPTIC INSTALLER DARIN OGG- Royal Flush Septic Phone: 360-790-3021
Address: PO BOX 1336 HOODSPORT, WA 98548
SEPTIC DESIGNER Adam Hunter-Jim Hunter and Phone: 360-753-1226
Associates
Address: PO BOX 162 OLYMPIA, WA 98507
Site Address: 10 N BASS PL
Primary Parcel Number: 422165300026
Permit Description: Install Holding Tank
Permit Submitted Date: 05/20/2022
Permit Issued Date: 06/30/2022
Issued By: Rhonda Thompson
Current Permit Fees Paid: $240.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/30/2025 (based on date of inspection)
Type of Work OSS New Construction
Components being Replaced: RV Holding Tank
Surfacing Sewage? No t:,R. Existing Failure? No
Shoreline? No I Horizontal Setbacks Met? Yes
Number of Bedrooms: 0 Drinking Water Source: Public Water System
Additional Details: 1200g holding tank
Permit Conditions:
3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.`
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
4 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND/OR DESIGN
APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: www.co.mason.wa.us/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
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OFFICIAL USE ONLY
DATE RECEIVED:
s "` MASON COUNTY
AMO T REC ED RECEI 1
W , dl. n COMMUNITY SERVICES �+� CO m
,�;jf Public Health(Community Health/Environmental Health) �� t. C co
�f� 360-427-9670,ext.400 or 360-275-4467,ext.400 /�
11
415 N.6th Street-Shelton,WA 98584 SWG -001 z 53
ON—SITE SEWAGE TANK ONLY APPLICATION
E XI
m 0
APPLICANT PHONE m
r
JIM BRIDGES 2533154922 z
MAILING ADDRESS-STREET,CITY.STATE.ZIP CODE E
21003 117TH ST E, BONNEY LAKE, WA 98391 m
xl
SITE ADDRESS-STREET,CITY,ZIP CODE '•
10 N BASS PL, HOODSPORT,WA 98548 I c
NAME OF DESIGNER PHONE
ADAM HUNTER 360-753-1226
NAME OF INSTALLER PHONE 0 IN
ROYAL FLUSH R
TYPE OF WORK(select one) DRINKING WATER SOURCE O I-
O NEW CONSTRUCTION/UPGRADES ❑ REPAIR/REPLACEMENT ❑ PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z Ir
COMPONENT(S)TO BE REPLACED/INSTALLED ® PUBLIC WATER SYSTEM LAKE CUSHMAN
❑ SEPTIC TANK 0 PUMP TANK CI RV HOLDING TANK BEDROOMS LOT SIZE I(
❑ OTHER N/A 0.2 I`"11
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r
0 t
CISURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE CI100FT+PUBLIC/COMMUNITY WELLS n
SUBMITTALS ❑ SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
O
CI PLOT PLAN(REQUIRED) CI TANK CROSS SECTION(REQUIRED) CI 10FT+DRINKING WATER SUPPLY LINES
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) CI 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
Io r
PLOT PLAN CHECKLIST Q
CI PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES \
CI WELLS WITHIN 100FT 0 WATER SUPPLY LINES CI DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... IN
O DIRECTION OF SLOPE/CONTOURS CI PERIMETER/CURTAIN DRAINS 0 NORTH ARROW CI SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex,locked gate)
POTLATCH CUSHMAN RD TO A LEFT ON RAINBOW WAY TO A RIGHT ON BASS PL TC
FIRST DRIVE ON THE RIGHT.
OFFICIAL USE ONLY BELOW THIS LINE _ _^
UPGRADE/FAILURE SOURCE(for reporting purposes) II^i1 I p' (
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT CI HOME SALE ['COMPLAINT CI OTHER:
1 I,i 1 1[w Ail
la �I id 11tt
COMMENTS I CONDITIONS I
111
k\) \damictil By . _ -
SEWAGE TANKS MUST BE LISTED UNDER DOH`LIST OF REGISTERED SEWAGE TANKS". TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED WITH RISERS
AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
___,..---.. (.7 (;)/ZS---- RT11121 C'SY\ bi/Do 1L7.,
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 07/09/2019