HomeMy WebLinkAboutSWG2023-000025 - SWG Application / Design - 2/1/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
ea: BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2023-00025
OWNER SLAWTER CHARITY & JOSEPH Phone:
MICHAEL
Address: 1830 EASTWOOD DR SE OLYMPIA, WA 98501
APPLICANT Jim Donahue Phone:
Address: PO Box 1346 TENINO, WA 98589
SEPTIC DESIGNER Adam Hunter-Jim Hunter and Phone: 360-753-1226
Associates
Address: PO BOX 162 OLYMPIA, WA 98507
Site Address: 91 NE BELAIRE DR
Primary Parcel Number: 222175000010
Permit Description: Replace septic tank
Permit Submitted Date: 02/01/2023
Permit Issued Date: 02/02/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 02/02/2024 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? Yes Horizontal Setbacks Met? Yes
Number of Bedrooms: 3 Drinking Water Source: Public Water System
Additional Details: 1200 g septic 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: masoncountywa.gov/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
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OFFICIAL USE ONLY--
DATE RECEIVED ^1 f
MASON COUNTY N
..I. - COMMUNITY SERVICES AMOU RECEIVE co cn
Public Health(Community Health/Environmental Health) - C N
360-427-9670,ext.400 or 360-275-4467.ext 40C A G •;/�l
41 S N.6th Street-Shelton,WA 98584 S /,' O• 1� -MO'L O 73
ON-SITE SEWAGE TANK ONLY APPLICATION r. n
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APPLICANT PHONE I-
JIM DONAHUE 3602393641 z
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MAILING ADDRESS-STREET,CITY.STATE,ZIP CODE g
PO BOX 1346, TENINO,WA 98589 co
SITE ADDRESS-STREET.CITY,ZIP CODE
91 NE BELAIRE DR, BELFAIR, WA 98528 Ir1
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NAME OF DESIGNER PHONE
ADAM HUNTER 3607531226
NAME OF INSTALLER 33p. PHONE v J
MAW Co s h-ti 02X-4- � t\LL4 Seetssssai
TYPE OF WORK(select one) DRINKING WATER SOURCE Cl)
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❑ NEW CONSTRUCTION/UPGRADES El REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z 1
COMPONENT(S)TO BE REPLACED!INSTALLED El
PUBLIC WATER SYSTEM BELAIRE
El SEPTIC TANK ❑ PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE IU►
❑ OTHER 3 0.17
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST W 10
0 I
El SURFACING SEWAGE El EXISTING FAILURE 0 SHORELINE El 100FT+PUBLIC/COMMUNITY WELLS n
SUBMITTALS 0 50FT+PRIVATE WELLS,SURFACE WATERS.STREAMS.RIVERS
O PLOT PLAN(REQUIRED) III TANK CROSS SECTION(REQUIRED) El 10FT+DRINKING WATER SUPPLY LINES
❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) 0 5FT+PROPERTY/EASEMENT LINES.FOUNDATIONS FOOTINGS
PLOT PLAN CHECKLIST rQ I°
O PROPERTY LINES AND EASEMENTS 0 EXISTING!PROPOSED STRUCTURES El EXISTING!PROPOSED OSS COMPONENTS AND LINES -I
O WELLS WITHIN 100FT III WATER SUPPLY LINES 0 DRIVEWAYS/PARKING III SURFACE WATERS,STREAMS,RIVERS,ETC... I—
CI DIRECTION OF SLOPE/CONTOURS El PERIMETER/CURTAIN DRAINS El NORTH ARROW 0 SCALE BAR
IC'DIRECTIONS TO SITE AND SITE CONDITIONS'(ex locked gate) ((� �} �YI
NORTH SHORE RD TO A LEFT ON BELAIRE TO SITE ON THE LEFT 1) 1 LI
FEB 01 2023
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By =I
OFFICIAL USE ONLY BELOW THIS LINE---
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 1AINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER:
COMMENTS/CONDI ONS
6t.0 Sep\C - n`C
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
/7/9 94)%14(I)S6YYk
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
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