HomeMy WebLinkAboutSWG2022-00401 - SWG Application / Design - 7/13/2022 415 N 6TH STREET,SHELTON,WA 98584
MASON COUNTY SHELTON:360-427-9670,EXT 400
Mt COMMUNITY SERVICES BELFAIR:360-275-4467,EXT 400
�. r ELMA:360-482-5269,EXT 400
9uldiny,Planning,Environmental Health,Community Wealth
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2022-00401
APPLICANT MULLINS PHYLLIS D Phone:
Address: 711 CREEKSIDE DR BELFAIR, WA 98528
OWNER MULLINS PHYLLIS D Phone:
Address: 711 CREEKSIDE DR BELFAIR, WA 98528
SEPTIC INSTALLER Shane Maples- MAPLES EXCAVATING Phone: 360-463-8474
Address: 911 SE Arcadia Road SHELTON, WA 98584
Site Address: 731 E CREEKSIDE DR
Primary Parcel Number: 222205200018
Permit Description: Install solids pump
Permit Submitted Date: 07/13/2022
Permit Issued Date: 07/15/2022
Issued By: Luke Cencula
Current Permit Fees Paid: $240.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 07/15/2025 (based on date of inspection)
Type of Work Other
Components being Replaced: Other
Surfacing Sewage? No Existing Failure? No
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Public Water System
Additional Details:
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.
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
5 Transport line within 10'of pressurized water supply line must be double sleeved and
meet WAC246-272A-0210(6).
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.
't OFFICIAL USE ONLY
�Apirm�_` DATE RECEIVED:
MASON COUNTY 1 . cn v
COMMUNITY SERVICES AMOUNT RECEIVE : RECEIVEDB
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ON-SITE SEWAGE TANK ONLY APPLICATION
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APPLICANT PHONE m
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE II— A co
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SITE ADDRESS-STREET,CITY,ZIP CODE c
711 C r e�.l/C s t d .� �,e l eIr (NQ ° .S-
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NAME OF DESIGNER PHONE I Q '+`
NAME OF INSTALLER PHONE 0 I ,.
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TYPE OF WORK(select one) DRINKING WATER SOURCE N
❑ NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z I
COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM r
❑ SEPTIC TANK 0 PUM TANK CICIRVHOLDING TANK BEDROOMS LOT SIZE I VI
eirOTHER .$ 'c.44 Iv et` 114 Okiletek in,A Cilre TAN W r l
OTHER DETAILS(select all that apply) SETBACK CHECKLIST 0 I N
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❑ SURFACING SEWAGE 'EXISTING FAILURE 0 SHORELINE 100FT+PUBLIC/COMMUNITY WELLS 0
SUBMITTALS OFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
❑ PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) tJ 1 T+DRINKING WATER SUPPLY LINESIrq
❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
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PLOT PLAN CHECKLIST 0 I�
❑ PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES ❑ EXISTING/PROPOSED OSS COMPONENTS AND LINES
❑ WELLS WITHIN 100FT El WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC...
(✓—]
❑ DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 , ALF BAB --
ti '`+t �{'y'�` I
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) O a ? ti.? 4.�
Ce'44-- of . 05`- & Cx) ' , 1. Jul_ 1 3 202Z I
By (iii),—_
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY v1AINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER:
COMMENTS I CONDITIONS ` (�
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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
..5: 15 , 14 5 _ 1115I
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
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