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HomeMy WebLinkAboutSWG2022-00231 - SWG Application - 4/26/2022 415 N 6TH STREET,SHELTON,WA 98584 MASON COUNTY SHELTON:360-427-9670,EXT 400 3._ r , COMMUNITY SERVICES BELFAIR:360-275-4467, EXT 400 ;; , ELMA:360-482-5269,EXT 400 13uildiay.Planning,Environmental l lest lh,Crmunity l ienlUr FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2022-00231 APPLICANT Royal Flush Phone: 3607903021 Address: P.o.box 1336 Hoodsport, WA 98548 OWNER NORDIN ROBERT W& PENNY L Phone: Address: 16305 3RD AVE E TACOMA, WA 98445 SEPTIC INSTALLER DARIN OGG- Royal Flush Septic Phone: 360-790-3021 Address: PO BOX 1336 HOODSPORT, WA 98548 Site Address: 361 N LAKE SURF DR Primary Parcel Number: 323095303032 Permit Description: Replace holding tank Permit Submitted Date: 04/26/2022 Permit Issued Date: 05/06/2022 Issued By: Rhonda Thompson Current Permit Fees Paid: $240.00 (additional fees may be required upon installation of system). Permit Expiration Date: 05/06/2023 (based on date of inspection) Type of Work OSS Repair Components being Replaced: RV Holding Tank Surfacing Sewage? No Existing Failure? Yes Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 0 Drinking Water Source: Public Water System Additional Details: Hagerman 1250 pump tank Permit Conditions: 1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 4 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 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. 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. OFFICIAL USE ONLY MASON COUNTY DATE RECEIVED: `r'7 �z n Ilf. 'I COMMUNITY SERVICES AMOUNT RECEIVED: r•©Z RECEIVED BY: W Cn : aVC o "'� Public Health(Community Health/EnvironmentalHealth) ' 360-427-9670,ext.4010 or 360-275-4467,ext.400 415 N.6th Street-Shelton.WA 98564 SWG)G qoac), _ ^ - S 1 O T z di ON-SITE SEWAGE TANK ONLY APPLICATION n n 3 APPLICANT nn n �\A PHONE U L r MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE C Qo be V—3(i) -`\C)0AS VCA 1 Jc °Ig5'-. C• co m SITE ADDRESS-STREET,CITY,ZIP CODE i t\ LC.CVe SU ,,\kO -WO.. CAg, s 0) , NAME OF DESIGNER PHONE C N NAM OF INSTALLER PHONE 1 ii TYPE OF WOR (select one) DRINKING WATER SOURCE ❑ NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT ❑ PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z {,�- r/ COMPONENT(S)TO BE REPLACED/INSTALLED PUBLIC WATER SYSTEM J r o SEPTIC TANK 0 PUMP TANK l RV HOLDING TANK BEDROOMS �;�/` LOT SIZE El OTHER Z' �C' OTHER DETAILS(select all that appty) 13 to Vv, TANKS)SETBACK CHECKLIST O ❑ SURFACING SEWAGE teEXISTING FAILURE 0 SHORELINE ,'100FT+PUBLIC!COMMUNITY WELLS n I SUBMITTALS // Izr 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS �� PLOT PLAN(REQUIRED) fd(TANK CROSS SECTION(REQUIRED) ' ' 1OFT+DRINKING WATER SUPPLY LINES ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 1Z- 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST r �- O PROPERTY LINES AND EASEMENTS ,'$ 1p.EXISTING/PROPOSED STRUCTURES {a EXISTING/PROPOSED OSS COMPONENTS AND LINES ❑ WELLS WITHIN 100FT WATER SUPPLY LINES .5 DRIVEWAYS/PARKING SURFACE WATERS,STREAMS,RIVERS,ETC... tjj 'Ise DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS NORTH ARROW 0 SCALE BAR �� t1 DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) Y-� kt.le? \Ck..0 i V o\C kAL) VA)� CA I,^VV O V-) k"-D-50 \-Go vv\pay- e v v-6 C. .?J V V'A. V.Cj -`\V--- \`r1 Saw \ ccc.-�.d,,, OFFICIAL USE ONLY BELOW THIS LINE ❑VOLUNTARY ]MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT 0 OTHER: COMMENTS/CONDITIONS \,r ►,.. SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED WTH 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 ci 6/7, 5 V-i-vy\tryvOsyn t/CitZ THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7I2015