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HomeMy WebLinkAboutSWG2023-00021 TANK ONLY - SWG Application / Design / As-Built - 1/27/2023 MASON COUNTY 415 N 6TH STREET,SHELTON, ,E 98584 SHELTON:360 427-9679670 EXT 400 BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT400 FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2023-00021 OWNER PUHN ROBERT 0 &THELMA L Phone: Address: 231 SE MORGAN RD SHELTON, WA 98584 APPLICANT PUHN ROBERT 0 &THELMA L Phone: Address: 231 SE MORGAN RD SHELTON, WA 98584 SEPTIC INSTALLER Shane Maples-MAPLES EXCAVATING Phone: 360-463-8474 Address: 911 SE Arcadia Road SHELTON, WA 98584 Site Address: 231 SE MORGAN RD Primary Parcel Number: 320245100007 Permit Description: Replace septic tank Permit Submitted Date: 01/27/2023 Permit Issued Date: 02/01/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 02/01/2024 (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? No Number of Bedrooms: 3 Drinking Water Source: Private Well/Spring Additional Details: Synder 1250 g plastic Permit Conditions: 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. 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. 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. OFFICIAL USE ONLY MASON COUNTY DATE RECEIVED. I _ �1 ` h 2 cn D Inn COMMUNITY SERVICES AMOLISSSD RECEI y W 0) •> Public Health Community Health/Environmental Health) C y 46015 N27.6thStr ext.t-43Shelton. It n, 198584.ext.400 SWG SO�� — 6 DO _ A ° 415 N.6th Street-Shelton,WA 98584 TT 0 N Z Cl) 13 ON-SITE SEWAGE TANK ONLY APPLICATION 3) Ai m n APPLICANT PHONE m CIV i d R,(hn / ROP-41- -PI Np-I yr -ak PL411 rl 3 U @-y 90. 19 3n Z c MAILING ADDRESS-STREET.CITY,STATE,ZIP CODE E a3I se Morga.n Rd' snertui t v0 q85S/- m 7, SITE ADDRESS-STREET,CITY,ZIP CODE ).3I s - Morgan Rd . ShP,I tD►1 t wA %5 8u NAME OF DESIGNER PHONE I ` NAME OF INSTALLER PHONE v I° Mcwie( Excav1TiVn9 (sham Haplf,sl 31o0-y-1o3- ? t9 LI ` h� TYPE OF WORK(select one) DRINK! G WATER SOURCE 0 ❑ NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z 1 4. COMPi NENT(S)TO BE REPLACED/INSTALLED El PUBLIC WATER SYSTEM F^t 111 N SEPTIC TANK PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE 1 ❑ OTHER 3 a•1,5 W �— OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r ❑ SURFACING SEWAGE d EXISTING FAILURE 0 SHORELINE ❑ 100FT+PUBLIC!COMMUNITY WELLS n SUBM! ALs 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS [a PLOT PLAN(REQUIRED) )TANK CROSS SECTION(REQUIRED) ❑ 10FT+DRINKING WATER SUPPLY LINES ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 0 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST r 1 ❑ PROPERTY LINES AND EASEMENTS ❑ EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES —I ❑ WELLS WITHIN 100FT 0 WATER SUPPLY LINES ❑ DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... I ❑ DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR 7 DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gets) � � � �� t� ��� ��l� Z^_v���I aeGornm► s,ion failed sP,ph t �o��,� . 1fT��lq�9l`_- on p se1pn c tan K, sa,rn e --� 5N'(DE - P 11e-S � OFFICIAL USE ONLY BELOW THIS LINE -- UPGRADE I FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY ,MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE OCOMPLAINT El COMMENTS/CONDITIONS //D //_`� V D Q--q\c(ce_ off' -e11,.. SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS". TANKS MUST MEET CURRENT MI ,SIZE REQUIREMENTS,EOUV4 WITH RISERS AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT RED QR`INAL APPRO INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVE _EIZBY f/ DATE / ; 1//2 D(b Z1(("L5 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 111111111.10.1111111111, j c p z a.a I-- U a a 0 w _ 111.11Mi ' (f) w z z J = LiAllikli� CA Q Ce CAo Wo Z .� 0,r, a 0 F- z z o to iv ilh pi �z °1- �o Q o Z CCN =� 3 w w 0 ��__ Ere E , - " m V O O >Q r i K W LU co hH , O J L 0 OwO� pm¢= o �J] N00 C7~ f 1 i N m Z E N xnx ' (.'J N W p'LL ~Q _ 0 mp D NI 0 Z wwOw f = Z .�DY O Z• mLUF- I ` cF/-� N Zm0 N~ �--� ' Q� FO-U d z d H Q8Z o a p —A N OCR W w oA 4 ILd Q = n i . z Z —J 5. a �, 0 L11ac Z z / o= 0 < > o D �� J C9 N rq J l o - Q w � 3 L 1 z t�LLI j W _I22 F- CL o 0 w 5 � o c w f— z p J 4 CU CU Z o_ (z - 0 ,a H C Q 'J Q‘ c c CC , _ I. d h. rn 4 c a 0 v, U J N _ w i J ) U CL Q • Q 0 Q Z w o / 1-1 U Z � �' acn w �Q- 0 fl 1 ww o iI 2 2 w. z `j� 0 0 Y �� U (D U z Z Q =L .1i , � � 1 M J --I rn v U Ili LU QCL 0_ 2 < Z 0O wa-tt/v -- 1004 H0USe! a„\k ti o� 0.1 � o° 4i ex B nE 4u. S N t k .per, .cco.N. ,rr. Qt CO cS� Co 0 WI w � N Z i) `V W 1- N Z A a. m 2 Z O U QN V �ara1 St-00004 Mason County OSS Installation Report pg.'{ FFI3 ! 0 ./123 ON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATI/ON tsy Permit Number SWG 2023-00021 100007 Applicant Name Thelma & Robert Puhn Subdivision (Name/Div/Block/Lot) Applicant Address 231 SE Morgan Rd. City, State, Zip Shelton,WA 98584 Installer Name Maples Excavating Site Address 231 SE Morgan Rd. Designer Name INSTALLATION CHECKLIST ❑ Full System Installation ©Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type Gravity Pretreatment Type >5 ft.from foundation? - - ❑ N/A El YES idNo >50 ft. from wells? - .- ❑ Zi ❑ Z >50 ft. from surface water? - - ❑ •.- ❑ Cleanout between building and tank? - - ❑ cr ❑ U Tank baffles present? - - ❑ '� ❑ d24" access risers over each compartment?- - ID ❑ W Effluent filter installed?- •- ❑ all ❑ U) Septic tank capacity (working) 1250 gal Manufacturer Snyder Plastics Itn D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO oO Manifold/D-box accessible from surface?- - CI CI mZ Check valves installed? - - ❑ ❑ ❑ OQ 2 Transport Line Size Schedule/Class Bedrooms installed (check one) ❑ 2 ❑3 ❑4 ❑ 5 ❑6 ['Commercial/Other >10 ft.from foundation?- - ❑ N/A ❑ YES ❑ NO 0 >100 ft. from wells?- - ❑ CI CI W >100 ft. from surface water? - - CI CI ti >10 ft.from potable water lines?- - ❑ ❑ ❑ Z > 5 ft. from property lines and easements?- - ❑ 0 ❑ Q CL > 30 ft.from downgradient curtain/foundation drains? - - ❑ El ❑ • Drainfield level and observation ports present - - ❑ Cl ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO `.r Pump tank capacity (flood) gal Manufacturer Q24" access riser(s) and accessible from surface?- - ❑ ❑ ❑ F- a Alarm or Control Panel Installed? - - ❑ CI CI 2 Control Panel equipped with Timer/ETM /Counter- - ❑ ❑ ❑ D a. Pump installed in ❑ Bucket or ❑ On Block or ❑ Other n'• Pump Make/Model ❑ Floats or ❑ Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8/21/2018 its Mason County OSS Installation Report pg. 2 Parcel# 320245100007 ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - Q■ YES 0 NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - Q■ 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,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installat on approval and related permits. 4PpRA FF Ile . ,. MgS�NCOUNTyB 2 12U?3 i:• ENS/ %le �IFNTk yeA(�,. N 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. .•-c.�, —4.---- 02/08/2023 Signature of Installer Date Shane Maples Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: \7 2 Signature o n �l'il ental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8i2112018 • HOUSE 8 "nk t+' Sr 4 I r o,M ` �D � ;t% M F 4 4 k Ikr, - wC „ A 4 PoRo C004/7,, 2120�3 �l1r Jev 1vt k HEAL) H V • 1001 �SE 1.409AA R.d , — — Parc:0 3202L1-6 -00001