HomeMy WebLinkAboutSWG2023-00040 TANK ONLY/AFTER THE FACT AS BUILT - SWG Application / As-Built - 2/10/2023 MASON COUNTY 415 N 6TH STREET,SHELTON, ,E 98584
SHELTON: ,S 42TON, EXT 400
584
.1W .,
BELFAIR:360-275-4467,EXT 400
Y. --- , Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2023-00040
APPLICANT BARKER LIVING TRUST JAMES D & Phone: 720-244-1140
KIMBERLY M
Address: 5841 E KNIGHT GLOW DR SCOTTSDALE, AZ 85266
OWNER BARKER LIVING TRUST JAMES D & Phone: 720-244-1140
KIMBERLY M
Address: 5841 E KNIGHT GLOW DR SCOTTSDALE, AZ 85266
SEPTIC INSTALLER TJ Goos-TJ's Excavating Phone: 360-490-0217
Address: 150 E MARISA PL SHELTON, WA 98584
Site Address: 81 E SHORELINE LN
Primary Parcel Number: 320215301041
Permit Description: Replace septic tank permit-After the Fact
Permit Submitted Date: 02/10/2023
Permit Issued Date: 02/13/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 02/10/2026 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Public Water System
Additional Details: Hagerman 1250 g
Permit Conditions:
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval 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/OR 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/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
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Mason County OSS Installation Report pg. 1 ,. I ASON COUNTY PUBLIC HEALTH
APPLICANT/ P 41Ih IIVFdiR itiTIb111
Permit Number SWG 20).3- COO`tfl Parcel #_3 Zd I 5-3 O) UW 1
Applicant Name i k-e v- ' -S Eddivision (Name Div/Block/Lot)
Applicant Address -''I I E \n 4‘t.- 6)o4.k.) Pr.
City, State, Zip 5Lo I t-5 c3 ( Z 5Z 6 Installer Name -0 Gr oo-)
Site Address q t 5koie(ike Dr Designer Name NJ A-
INSTALLATION CHECKLIST
❑ Full System Installation 121,Tank(s)Only ❑ Drainfield Only 0 Repair ElOther
System Type s ., kV 1 Pretreatment Type
>5 ft. from foundation? - n �• ❑ N/A [AYES ❑ NO
>50 ft.from wells? -� �.-I. - ❑ 3 0
>50 ft.from surface water? - - - - ' ❑ ® ❑
FC� (i 20"3
HCleanout between building and tank? - _ ❑ a. ❑
U Tank baffles present? - .` ❑ ® 0
d24"access risers over each compartment? By .. ❑ El
W Effluent filter installed?- - ❑ 13- ❑
ch
Septic tank capacity (working) )z,-0 gal Manufacturer irev tAAct v)
CID-box water level and speed levelers used? - - 4 N/A ❑ YES ❑ NO
oO Manifold/D-box accessible from surface? - 0 CI CI
CO Check valves installed? - - Q ❑ ❑
OQ
2 Transport Line Size Schedule/Class
Bedrooms installed (check one) 8-2 0 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other
>10 ft. from foundation?- - ❑ N/A ❑ YES ❑ NO
>100 ft. from wells?- - ❑ .l ❑
W >100 ft. from surface water? - - ❑ El El
LI >10 ft. from potable water lines?- - 0 ❑ 0
Z > 5 ft. from property lines and easements?- - 0 ® ❑
Q
ii cc > 30 ft. from downgradient curtain/foundation drains? - - a ❑ ❑
o
Drainfield level and observation ports present - - Q 0 ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - 11- ❑ ❑
Pump tank setbacks consistent with septic tank? - N/A ❑ YES ❑ NO
`.t Pump tank capacity (flood) gal Manufacturer
< 24" access riser(s)and accessible from surface?- - 0 ❑
H
a. Alarm or Control Panel Installed? - 0 ❑
2 Control Panel equipped with Timer/ ETM /Counter- - ❑ ❑
m
d Pump installed in 0 Bucket or ❑ On Block or ❑ Other
a• Pump Make/Model ❑ Floats or ❑ Transducer
a.
a Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 821/2018
Mason County OSS Installation Report pg. 2 Parcel#
ABANDONMENT RECORD
Were existing septic components abandoned ast�part
of this project? - - Y S ❑ NO
If yes, please describe: S Te€I I�v�C1 1 o S Pck \re Cvty -ec/I
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - ❑ YES ❑ NO
RECORD DRAWING
This Is a permanent record and must be accurate and descriptive enough to re-locate In the need of maintenance activities and future development. Typical Record
Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines,
wells,observation ports,cleanouls,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
,. Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I certify that the system has been installed in accor-
the septic design stamped "APPROVED"by Mason dance with the septic design stamped `APPROVED"by
County Public Health and that any deviations shown Mason County Public Health and that any deviations
here have been cleared/approved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
20)4
Signature f Installer Date
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
/t3/Z 5
Signature of Environmental Health Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8/21/2018
RECORD DRAWING (continued)
APPROVED
FEB 13 2023
MASON COUNTY ENVIRONMENIAI HEALTh
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