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Home My WebLink AboutSWG2023-00082 - SWG Application / Design - 3/10/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670, EXT 400 111. BELFAIR: 360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT 400 IAA FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2023-00082 OWNER RITTER JOSEPH & MCALL Phone: Address: 781 E ROAD OF TRALEE SHELTON, WA 98584 APPLICANT RITTER JOSEPH & MCALL Phone: Address: 781 E ROAD OF TRALEE SHELTON, WA 98584 SEPTIC INSTALLER Doug Hemley- Installer Phone: 253-509-0446 Address: 14614 Talmo Dr NW GIG HARBOR, WA 98332 Site Address: 781 E ROAD OF TRALEE Primary Parcel Number: 321275100076 Permit Description: Replace pump tank Permit Submitted Date: 03/10/2023 Permit Issued Date: 03/10/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 03/10/2026 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Pump Tank Only Surfacing Sewage? No Existing Failure? Yes Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 4 Drinking Water Source: Public Water System Additional Details: Hagerman 1250 pump tank Permit Conditions: 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. 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 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 DATE RECEIVED: •� MASON COUNTY • 70 cn > COMMUNITY SERVICES AMOUNT RECENED: co RECEIVED BY: v m �S`b C'�� cn m Public Health(Community Health/Environmental Health) C cn 360-4279670.ext.400 0!360 27S-a+67,ext.400 ('' yr: z3 //�� /)� (n O 4thN.6th Street Shelton,WA 98584 SWG - Q�� XI Z (n ON-SITE SEWAGE TANK ONLY APPLICATION m m APPLICANT PHONE r MAILING ADDR SS-STREET.CITY,STATE,ZIP CODE g CO 78( E r d o f f rti (ee S 4e l-7/Gg c.✓4 q yS�y m SITE ADDRESS-STREET,CITY,ZIP CODE 7X1 I r( o -C +cc(/ee 5klk1 (.✓4 ?ssey IW NAME OF DESIGNER PHONE I I v ,1' /7,-.410/t 360 -75 3- 1,9,96- _ NAME OF INSTALLER PHONE 0 Ckt 4 tie/,•) iy 360 - a ' - 3©06 N TYPE OF K(select One) l/ DRINKING WATER SOURCE ❑ NEW CONSTRUCTION/UPGRADES [ REPAIR/REPLACEMENT ❑ PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z COMPONENT(S)TO BE REPLA DI INSTALLED PUBLIC WATER SYSTEM ❑ SEPTIC TANK BrPUMP TANK ❑ RV HOLDING TANK BEDROOMS LOT SIZE ❑ OTHERLI 0 w I_� OTHER DETAILS(Select all that apply) TANK(S)SETBACK CHECKLIST Q n I ❑ SURFACING SEWAGE .PJ EXISTING FAILURE 0 SHORELINE 0 100FT+PUBLIC/COMMUNITY WELLS (� SUBMIT S � 0 SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS I\_) Id E PLOT PLAN(REQUIRED) 4ANK CROSS SECTION(REQUIRED) ❑ 10FT+DRINKING WATER SUPPLY LINES I ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 0 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS �\ r PLOT PLAN CHECKLIST 0 IC ❑ PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES ❑ WELLS WITHIN 100FT 0 WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... I J ❑ DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR I v( , DIRECTIONS TO SITE AND SITE CONDITIONS.(ex locked gate) / OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY MAINTENANCE/PUMPING 0 BUILDING PERMIT <ME SALE ['COMPLAINT ❑OTHER: COMMENTS/CONDITIIONS 44( 1C4CQ ? C 1 /111c• — 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 - �) ► blzL1 ,, 31r01f ON THE MASON COUNTY WEBSITE �REVISED7/9/2019 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW 1Stl0-32Jd NVWi330VH SIN :31VOS 699L-L89 (09£) :XVd 999L-L99 (09£) '3NOHd 1-d 09Z l '8 d 09Z I. •N•a'° v0926 VM'CINf1O21J 3111V9 L60£XO9'O'd rai 1-s05zl• `so9zI. 031dV210 .ONI JNI2�33NIJN� )1 a.. S137an!NIA STY I3nVNI 4l/£Zl9 :31V0 e a r <I E tizt' ,''; =-NO0 col 1 t7g Q�Q ON=ui2 OA lc qg LL 3 "ip u oC Q Q\O on Y ! 3!: : 1 a 'il IF-2 , / r - `, 'n l° ` '- / - d O 1. \ c r — _:?o '.am n ^• N�f�I i vt l'i N 0,4. ,,F, :04 4 ,„ ! Hill �� . or._, 00 _ L§ .. 0 . ozjn 0 a m ird Z�� h .\�. LYY1YYsvvv.n.ir�..rv.- V .,W L N N'0 � 6r,) o02 ,09 ��., ! 25 J + 0C RQ a { u `a 2b CD J oe �% 1-d OSZI f1SOSZ1.99 2 rG x e . yl cMv W �'� dOSLI 15QSLI.S� ,( ~ �'e ��a✓y, - \J O t53 ro O 2a O 7 c _ s oN N 1j J- ,-- u3 (� Q x = i W ! o �' L.i. Q M O l Q - v g- - y / O w_c ^E. 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" • , • . . • . • • .. • . • Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SVVG Lt , 7, COOS Z- Parcel # 3,2/.Q7FiCk a 76 Applicant Name 31de_ R,die,- Subdivision (Name/Div/Block/Lot) Applicant Address 721 A" A cl 04' ret 1e City, State, Zip AAe lam., WA 4jc j Installer Name De,45 AEA:ley Site Address �.,,,a Designer Name 7-.'rr A'.,A•k r INSTALLATION CHECKLIST • ❑ Full System Installation ["Tank(s)Only ❑ Orainfieid Only ❑Repair ❑Other System Type_ k)i( h's Xk1Y 4'1+ - p rQS S L.4 Q Pretreatment Type >5 ft. from foundation? - • ❑ N/A ❑YES ❑ NO >50 ft. from wells? • '' ❑ ❑ z >50 ft. from surface water? • - -- - ' 0 0 0 Q Cleanout between building and tank? - • ❑ ❑ 0 U Tank baffles present? • ❑ 0 ❑ t— 24" access risers over oath compartment?• - ❑ 0 0 W Effluent filter installed?• - 0 0 to Septic tank capacity (working) gal Manufacturer C] D-box water level and speed levelers used? • • ❑ NtA ❑YES ❑ NO D-1 0 ❑ O ManifoldrD•box accessible from surface?• • ❑ ❑ a?z Check valves installed? - - ❑ 0 0 a SchedulelClass c Transport Line Size Bedrooms installed (check one) 0 2 0 3 4 ❑ 5 0 6 ❑Commercial/Other >10 ft.from foundation?- - - 0 N/A ❑ YES ❑ NO >100 ft. from wells?• - 0 0 ❑ CI 0 0 --I >100 it. from surface water? • - _ ❑ 0 >10 ft. from potable water lines?- 0 ❑ -• 5 ft. from property lines and easements?• ❑ ❑ ❑ a > 30 ft. (ruin downgradient curtain/foundation drains? - - 0 ❑ ❑ C Drainfield levet and observation ports present - - ❑ 0 0 ❑ Graveless chambers or 0 Clean gravel used? (check one) ❑ ❑ Proper cover installed over drainfield?• - 0 Pump tank setbacks consistent with septic tank?• - - - 0 NrA 2'YES ❑ NO • Pump tank capacity (flood) _aro gal Manufacturer 045dt PSIs4 Z El0 Tr 4 24"access riser(s)and accessible from surface?--- ---- 0 Q�.�/r 0 t-• -- - - a. Alarm or Control Panel Installed'? - - - --- - -- - ---- -- - - - L� ❑ Control Panel equipped with Timer I ETM/Counter- ❑ n- Pump installed in 0 Bucket or On Block or 0 Other Er - n- Pump Make/Model ape j j er .v- IJ-3 Lr t-loats or 0 Transducer ft a Tank draw down / ,2,s- in/min Pump capacity i(� gpm Squirt Height Pump on time ,' Pump off time 4Ars Daily flow set at We, 90 , • Mason County OSS Installation Report pg. 2 Parcel # Ja.t),1C1t?D 0- too ABANDONMENT RECORD Were existing septic cornpon is abandoned as part of this project? -. BYES ❑ NO If yes, please describe: 02hV' ,03 Se-L\Were all components pumped oul and properly abandoned per WAC246-272A-0300? _ YES ❑ NO RECORD DRAWING Thus la a prmwnant record and roust NI'accurate and de►crlpttve enough to re-iotalu In rue need of maNllMaoca wetly lbws and future dewlopMrnt Tyo al R.Csmn LvawlrVI canal. Dienheld d nwrufett3 ortnlatxui A teyoul.SootrciIump tent,:r c t iti.Nam arrow reserve draiMlrw.t.nKW:ng and prnt,Y,ed tnradingt 1traxddn M rsgs,*swims. .v.rlG.pboeoys n I)Nli-rLaar A,tl,and olh+r inninu a3nc+n7:024 Kota. woomplele rtoetwd fooffb ley iYeauo addhhoml delay%In WO drstotat«n anfrmvat and related permits. ❑ Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER!ENGINEER I certify that 1 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 devi&tions 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 Meson County Public Health and meet all State myself end 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. Signature of ?staller Dot Do kk-izYr/t Printed Nat&of Signet; MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: �< 4 /(6 (23 Signature of EnvuonrnAnta►Health Specialist Date (stamp, signature and data) THIS FORM iatAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE U9'tntlra M t,:n t n . .. . ' . . . • . ciA 0- -1E . 0 c • . 3 -.• • • . • 5.-_._.... , • -7-‘,..= . . . . • • --. ..--- --._------- ---------- ---(s -4----- .. . ______ _____,____. • •------- _ ..._. . •---:--- ___—•„....... ______ . .Ri____...1 . •• ... ---c som.............. .......... ...e. ... . ..... __......_....:.....—j. , , - ..-.--•-,.. . 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