HomeMy WebLinkAboutSWG2023-00003 - SWG Application / Design - 1/5/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
r4: BELFAIR:360-275-4467,EXT 400
N Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00003
APPLICANT ROBINSON AMANDA Phone:
Address: 580 SE ARCADIA RD SHELTON, WA 98584
OWNER ROBINSON AMANDA Phone:
Address: 580 SE ARCADIA RD SHELTON, WA 98584
SEPTIC DESIGNER Adam Hunter-Jim Hunter and Phone: 360-753-1226
Associates
Address: PO BOX 162 OLYMPIA, WA 98507
Site Address: 580 SE Arcadia Rd
Primary Parcel Number: 320291300370
Permit Description: Tank replacement and lift tank addition for shop
Permit Submitted Date: 01/05/2023
Permit Issued Date: 01/26/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 01/05/2026 (based on date of inspection)
Permit Conditions:
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
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.
4 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
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 DESIGN APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.gov/health/environmental/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
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OFFICIAL USE ONLY
DATE RECEIVED: 1 ' 0 r t�� coD
MASON COUNTY
COMMUNITY SERVICES c N
AMOUNT RECEf3t RECEIVED BY: � W m.11. . � v
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Public Health(Community Health/Environmental Health) - (n
415 N.6th Street
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ON-SITE SEWAGE TANK ONLY APPLICATION
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APPLICANT PHONE
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AMANDA ROBINSON 360-742-4161 z
MAILING ADDRESS-STREET,CITY,STATE.ZIP CODE 3
580 SE ARCADIA RD, SHELTON, WA 98584 co
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SITE ADDRESS-STREET.CITY.ZIP CODE
580 SE ARCADIA RD, SHELTON, 98584 V
NAME OF DESIGNER PHONE
ADAM HUNTER 360-753-1226
NAME OF INSTALLER PHONE v I C
TBD Z �Q)
TYPE OF WORK(select one) DRINKING WATER SOURCE O n
❑ NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT III PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z ..l
COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM I r
El SEPTIC TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE I,--
❑ OTHER 3 5 CO
CHECKLIST r
OTHER DETAILS(select all that apply) TANK(S)SETBACKO
❑ SURFACING SEWAGE El EXISTING FAILURE 0 SHORELINE El 100FT+PUBLIC/COMMUNITY WELLS n I^
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SUBMITTALS El SOFT+PRIVATE WELLS,SURFACE WATERS.STREAMS,RIVERS X
El PLOT PLAN(REQUIRED) III TANK CROSS SECTION(REQUIRED) El 10FT+DRINKING WATER SUPPLY LINES10
❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) El 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS.FOOTINGS
PLOT PLAN CHECKLIST 0 '�J�+
0 PROPERTY LINES AND EASEMENTS El EXISTING/PROPOSED STRUCTURES El EXISTING/PROPOSED OSS COMPONENTS AND LINES
O WELLS WITHIN 100FT ID WATER SUPPLY LINES El DRIVEWAYS/PARKING El SURFACE WATERS,STREAMS,RIVERS,ETC... I-i
O DIRECTION OF SLOPE/CONTOURS El PERIMETER!CURTAIN DRAINS El NORTH ARROW El SCALE BAR IC)
DIRECTIONS DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) �
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OFFICIAL USE ONLY BELOW THIS LINE �
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UPGRADE/FAILURE SOURCE(for reporting purposes) C..71
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT OHOME SALE ['COMPLAINT ❑OTHER: No C
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COMMENTS/CONDITIONS W
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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 APP CATION APPROVED/ISSUED BY DATE
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T S MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED t2/72015
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