HomeMy WebLinkAboutSWG2023-00082 TANK ONLY - SWG Application / Design / As-Built - 3/10/2023 c
MASON COUNTY 415 N 6TH STREET, 0-427 967 , A 98584
SHELTON:360-427-9670,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: SWG2023-00082
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:7-__ MASON COUNTY /6 . 2 u, D
(cr, .
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COMMUNITY SERVICES AMOUNT RECEIVED: � ,yt RECEIVED BY�n /t/� m
cn
Public Health(Community Health/Environmental Health) J (/t/ -/�'7//-!1//�/- /� < 0)
415 N.6th tr. r-xt.Shelton.
It n.3 WA ,ert.400 SwG /) 2 2 — 0 0 2 / (n Q
415 N.6th Stteet-Shelton,WA 98584 I//// J � �`/ o �
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ON-SITE SEWAGE TANK ONLY APPLICATION
m
APPLICANT PHONE m
Al, ile r I `2?O /- 6 Vie?-• Y.5136 Z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE g
03
7R E r d o 4 -{-r,; (eL s 4 l-/-/7 rN 4 `Ih' - y m
73
SITE ADDRESS-STREET.CITY,ZIP CODE
7X J pc/ o +r-de€ 5k Hu. q cA/,9 YXSsy I/,
NAME OF DESIGNER PHONE I v
{, ,�, N 7/.4-,- 360 --- . .' i a a6 I�
NAME OF INSTALLER PHONE
t>,. ge.,1 /e/ :36v - .. ,y" - 300 6 N I`v
TYPE OF K(select one) I DRINKING WATER SOURCE O
❑ NEW CONSTRUCTION/UPGRADES ❑/RE/PAIR/REPLACEMENT ❑ PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z I 1
COMPONENT(S)TO BE REPLA D/INSTALLED 7.PUBLIC WATER SYSTEM 1
❑ SEPTIC TANK PUMP TANK ❑ RV HOLDING TANK BEDROOMS LOT SIZE �'] �l I f
O OTHER 7 D. vO,,/ W
OTHER DETAILS(select all that apply) TANK(S) I— I_�
SETBACK CHECKLIST 0
CISURFACING SEWAGE erEXISTING FAILURE 0 SHORELINE III 100FT+PUBLIC/COMMUNITY WELLS r
SUBMMII ,
ALS I 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS \
'di PLOT PLAN(REQUIRED) CYfANK CROSS SECTION(REQUIRED) 2 10FT+DRINKING WATER SUPPLY LINES
I
❑ PUMP DETAILS(IF APPLICABLE) ElWAIVER(S)(IF APPLICABLE) 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST r 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...
O DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(tor reporting purposes)
0 VOLUNTARY . MAINTENANCE/PUMPING 0 BUILDING PERMIT TOME SALE ['COMPLAINT 0 OTHER:
COMMENTS/CONDITIONS
'Q \CA,CIL V"V�r 1
4 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 DRAWNG AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED!ISSUED BY DATE
- -1 1 L)/.Lfi :IN,i. i� )1( v 17—3
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON
THE MASON COUNTY WEBSITE REVISED 7/9/2019
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Mason County OSS Installation Report pg. 'I MASON COUNTY PUBLIC HEALTH
APPLICANT!PERMIT INFORMATION
Permit Number SWG Z'OZ, -- CVOS Z- Parcel# 7,2 f.271--! a 76
Applicant Name 3'ns g, ,le,. Subdivision (Name/Div/Block/Lot)
Applicant Address 781 A- ,t d n-F' 7-ft to
City, State, Zip s/he M, i j,,JA gj.spf, Installer Name 1:70y5 leim Irr7
Site Address _game Designer Name 7-1101 A•-.4•{:,
INSTALLATION CHECKLIST
❑ Full System Installation BiTank(s)Only 0 Dralnfleld Only ❑Repair 0 Other
System Type_.1) l-e(Akin-e41+" - p recS whQ. Pretreatment Type
>5 ft. from foundation? - - ❑ NIA ❑YES 0 NO
>50 ft. from wells? • - '- 0 0 ❑
Z >50 ft. from surface water? - . 0 0 0
h Cleanout between building and tank? - • CI ❑
U Tank baffles present? 0 ❑ 0
1- 24" access risers over each compartment?- - 0 0 0
a 0 0
Ili Effluent filter installed?-- - - - - ❑
N
Septic tank capacity (working) qal Manufacturer
C D-box water level and speed levelers used? - -- - - - -- - 0 N!A ❑YES ❑ NO
� �
O ManlfoldlD•box accessible from surface?• - ❑ 0 0
51Z Check valves Installed? - - ❑ 0 0
0 Q SchedulelClass
Transport Line Size
Bedrooms Installed (check one) 0 2 0 3 4 0 5 ❑6 ❑Commercial101her
>10 ft.from foundation?- - ❑ NIA [] YES ❑ Na
t7 >100 ft. from wells?- - 0 ❑ 0
--I >100 ft. from surface water? • - - 0 0 0
u. >10 fl.from potable water lines?- 0 ❑
c2 > 5 ft, from property lines and easements?- - 0 0 0
a > 30 ft. from downgradient curtalnlfoundetion drains? - - 0 ❑ 0
C Drainfteld level and observation ports present - - 0 0 0
0 Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 0 0
Pump tank setbacks consistent with septic tank?- - - - 0 NIA g YES ❑ NO
Pump tank capacity (flood)•i94-0 gal Manufacturer_mil it .
Z 0
24"access riser(s)and accessible from surface?- • ❑ rif
I—
a. Alarm or Control Panel installed? - : El l,/
El
E Control Panel equipped with Timer/ ETM I Counter- • ❑ L`1 ❑
D
a Pump installed in ❑ Bucket or [vj/On Block or ❑ Other �.,/
M. .
Pump Make/Modelpe f j er Al- 15:3 Lr rloals or ❑ Transducer
2 Tank draw down /4_.2$ infmin Pump capacity y4 gpm Squirt Height 2 ft
n.
Pump on time g 'p Pump off lime 6Art Daily flow set at giro grid
tipIi'tm:1:01r
Mason County OSS Installation Report pg. 2
Parcel# g-t a:I�fcDo/67
ABANDONMENT RECORD
Were existing septic compare is abandoned1JJ as part of this project? -- - ----
• dYt=S � NO
If yes, please describe: �" WO_\--)SF.A 0 Na
Were all components pumped eul and properly abandoned per WAC246-272A-0300?
YES
RECORD DRAWING
MIS If a permanent word and must be accurate and desctlptW■enough to le-locate lit the naici of nwintenonta ecWltiao and future development- ¶y rn nl Reccao
Dratidnys Retain: Gtr.:hreld A manifold or ntatcur A I.iynul.6olt:Pump MA:r,Unktri,North anew,gyve oralnGut:l.tlatotrj and propred L t l' �n;,v.,or omoi I rleutl-.
n
ll eTr
*Au.obauirm urns d,i,1M1J9,and otr,✓f Inr,ni?,1 r cnt,cuiss po""t• I"cirrpletu Rnaxd Qiahirft nrnt treat'-adJilrernl Aalays v I.n t n f
Record Drawing Altacned
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 eccor-
!he septic design stamped'APPROVED"by Mesone t the septic
designt"APPROVED'
�by
County Public Health and That any deviations shown Mason Public Health and that deviations
own
re have bean cleared/approved by
hare have been cto»red/apprnved by both thel designer nhysalf and Meson County Public Health and meetall
h
and Mason County Public Health Arid meetState and Mason County Codes
and Mason County Codes.
I further certify that ail information contained on this 1 further
and certify attached Record all
informa
D atiowingcos accuntained
irate,
this
form and attached Record Drawing is accurate,
Sr0ftnturn of tstatier
-f Dab
1-06
Printed Na o of Signor; .
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
1c6 (23
5igr?atarir of E)Hrrronrn ntal Health Specialist Datr,
(stamp, signature and data)
THI5 FORM MAY UE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE ''t'''i16"'''' ''r'
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