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HomeMy WebLinkAboutSWG2023-00060 TANK ONLY - SWG Application / Design - 3/1/2023 C.G. OFFICIAL USE ONLY DATE RECEIVED - "'l MASON COUNTY 3 • t • u) › COMMUNITY SERVICES AMO • RECEIVE CO v m - Public Health(Community Health/Environmental Health) R (/) 360-47-9 ext. or 360.275-4467 ext.400 (n O CISN. thStrreet-Shelron,WA 98584 SWG A6 )3dri de 0 0 O Z fn ON-SITE SEWAGE TANK ONLY APPLICATION m n APPLICANT PHONE m (- BRANDY BENNETT 360-473-6896 z MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE g co 1751 E AGATE RD, SHELTON, WA 98584 m SITE ADDRESS-STREET,CITY,ZIP CODE 1751 E AGATE RD, SHELTON, WA 98584 I N NAME OF DESIGNER PHONE Pi ADAM HUNTER 360-753-1226 NAME OF INSTALLER PHONE a BAYSHORE CONSTRUCTION 360-866-9200 C Io TYPE OF WORK(select one) DRINKING WATER SOURCE N O ❑ NEW CONSTRUCTION/UPGRADES ® REPAIR/REPLACEMENT Ian PRIVATE INDIVIDUAL WELL El PRIVATE TWO-PARTY WELL Z {�- COMPONENT(S)TO BE REPLACED/INSTALLED ❑ PUBLIC WATER SYSTEM I I n El SEPTIC TANK ❑ PUMP TANK ❑ RV HOLDING TANK BEDROOMS LOT SIZE ❑ OTHER 3 2.73 Or 00 IV)OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST I ❑ SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE 0 100FT+PUBLIC/COMMUNITY WELLS 0 I _ SUBMITTALS CM 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS K) El PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) CI 10FT+DRINKING WATER SUPPLY LINES © PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) IN 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST I— GO a❑ PROPERTY LINES AND EASEMENTS CI EXISTING/PROPOSED STRUCTURES El EXISTING!PROPOSED OSS COMPONENTS AND LINES I] WELLS WITHIN 100FT CI WATER SUPPLY LINES El DRIVEWAYS/PARKING ElSURFACE WATERS,STREAMS,RIVERS,ETC... " ❑a DIRECTION OF SLOPE/CONTOURS El PERIMETER!CURTAIN DRAINS ID NORTH ARROW El SCALE BAR I 'ta DIRECTIONS TO SITE AND SITE CONDITIONS.(ex.locked gate) AGATE RD SOUTH TO A LEFT AT DRIVE FOR 1751 OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER: COMMENTS/CONDITIONS v4; 0 T __. 01 2023 SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM 9 EQUIREMENTS,EQUIPPED WI SERS AND LIDS TO SURFACE.AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REFIRED FOR Fl PROVAL. t INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATr �_""P` t DATE v \avvv:340 1 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 Mv, MASON COUNTY 415 N 6TH STREET,SHELTON, ,E 98584 SHELTON: ,S 42TON, ,EXT 400 584 BELFAIR:360-275-4467,EXT 400 jr Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2023-00060 4 OWNER BENNETT ET AL BRANDY C Phone: Address: 1751 E AGATE RD SHELTON, WA 98584 APPLICANT BENNETT ET AL BRANDY C Phone: Address: 1751 E AGATE RD SHELTON, WA 98584 SEPTIC DESIGNER Adam Hunter-Jim Hunter and Phone: 360-753-1226 Associates Address: PO BOX 162 OLYMPIA, WA 98507 SEPTIC INSTALLER BRANDON THOMPSON- Bay Shore Phone: 360-866-9200 Construction Address: 2103 HARRISON AVE NW STE 2774 OLYMPIA, WA 98502 Site Address: 1751 E AGATE RD Primary Parcel Number: 320013390003 Permit Description: Replace septic and pump tank Permit Submitted Date: 03/01/2023 Permit Issued Date: 03/03/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 03/03/2024 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Septic and Pump Tanks Surfacing Sewage? No Existing Failure? Yes Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 3 Drinking Water Source: Private Well/Spring Additional Details: Sound Placement septic and pump tank combo 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. 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 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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