HomeMy WebLinkAboutSWG2023-00099 - SWG Application / Design - 3/17/2023 MASON COUNTY 415 N 6TH STREET, SHELTON,WA 98584
SHELTON: 360-427-9670,EXT 400
eM :,
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: SWG2023-00099
APPLICANT DOYLE RAYMOND A & SUSAN Phone:
Address: 331 SE STATE ROUTE 3 SHELTON, WA 98584
OWNER DOYLE RAYMOND A & SUSAN Phone:
Address: 331 SE STATE ROUTE 3 SHELTON, WA 98584
SEPTIC INSTALLER BRANDON THOMPSON- Bay Shore Phone: 360-866-9200
Construction
Address: 2103 HARRISON AVE NW STE 2774 OLYMPIA, WA 98502
SEPTIC DESIGNER Adam Hunter-Jim Hunter and Phone: 360-753-1226
Associates
Address: PO BOX 162 OLYMPIA, WA 98507
Site Address: 331 SE STATE ROUTE 3
Primary Parcel Number: 320311100100
Permit Description: Replace septic tank
Permit Submitted Date: 03/17/2023
Permit Issued Date: 03/21/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 03/17/2026 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 4 Drinking Water Source: Private Well/Spring
Additional Details: 1200g minimum operating capacity septic tank
Permit Conditions:
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.
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.
c.0
OFFICIAL USE ONLY
MASON COUNTY DATE RECEIVED: 2 1 IT 1 9-3
COMMUNITY SERVICES J55 yyy��� ��' 0 `)
~ •• AMOUNT RE D RECEIVED BY: 1 J/L�t� W Cl)
t'1` v` v rtt
Public Health(Community Health/Environmental Health) WOO
C t)
36P427-%70•e •Shelton.
WA 8584 ext.400 SWG �O�^ I \l \O�1/I O 0
415 N.6th Street�Shelton.WA 98584 Ii,� - I`,/N`,/l (Al`�11
Z cii
ON-SITE SEWAGE TANK ONLY APPLICATION
D 73
3 n
APPLICANT PHONE rn m
BAYSHORE CONSTRUCTION 360-866-9200 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE —1^ g
2103 HARRISON AVE STE 2774, OLYMPIA, WA 98502 uII u��jr Co
4 70
SITE ADDRESS-STREET,CITY.ZIP CODE MAR 17 2023 ,;
331 SE STATE ROUTE 3, SHELTON, WA 98584 _ Li
NAME OF DESIGNER PHONE
ADAM HUNTER 3607531226_By � �
NAME OF INSTALLER PHONE v IC,
BAYSHORE CONSTRUCTION 360-866-9200 <
TYPE OF WORK(select one) DRINKING WATER SOURCE N '"
O
❑ NEW CONSTRUCTION/UPGRADES I'ii REPAIR I REPLACEMENT Iia PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL z �.
COMPONENT(S)TO BE REPLACED!INSTALLED 0 PUBLIC WATER SYSTEM I
El SEPTIC TANK ❑ PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE
❑ OTHER 4 1 w
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r r---
O
❑ SURFACING SEWAGE El EXISTING FAILURE ElSHORELINE 0 100FT+PUBLIC/COMMUNITY WELLS n
SUBMITTALS 0 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
O PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) El 10FT+DRINKING WATER SUPPLY LINES ICY
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) ❑- SFT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST 0 I---
O PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES El EXISTING!PROPOSED OSS COMPONENTS AND LINES -/
O WELLS WITHIN 100FT 0 WATER SUPPLY LINES 0 DRIVEWAYS/PARKING El SURFACE WATERS,STREAMS,RIVERS,ETC... IC)
III DIRECTION OF SLOPE/CONTOURS El PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex locker/gate)
SR ROUTE 3 SOUTH FROM SHELTON TO SITE ADDRESS (331) ON THE RIGHT.
OFFICIAL USE ONLY BELOW THIS LINE -
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY,MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER:
COMMENTS I CONDITIONS
V----Q.c G <CWL .-i- 1.1A V.--
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
f z1 IZ 1 -,1-1\ wk,VC6144 73121 /Z 3
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
>
m
X7
0
X_
a
m
r
O
n
_____1/2/
O
f.. zO
g�j�ti ,'try
o
` .�ii z^' e , r
(Ti .
to .11%ii W O
W
W
N
W
i H
•
.N
0
m
o
N
O
O
D "
U) O
mX
r_ 111--------
z
mm
D
F
m
v
0
i n _ 'O
D
o Z
0 I
D
Ci D
m Z
m x
r h ( O0
-I z
v X } O m
C
O
Z X 1 O
o �
a -1 Z
m m
co
t 1 H -
•
m I co •
• Z
C
to m m
C., > rmi, mm7) - -i I > Z
-gym < Om = z
C m ,IOm V7< -, Ca— m
-1 m ( K D m D w
I = z z c c z m
O D
O ° j p p r_-
C { - o) O m �
O CO Z a m m p D
0m -i -I O U (n (7'
O i tny " OC
Ir C
m Za7 m 5zj A
IV
-I 0 m m O A 1. m
O m m cco z D 2 -<
Z a K m O z < Z
-I > 20 -nom
0
O m p - O m m
(n H r0mc <
zi Z7 < m v -I _r 70 m C
A S
m 11vN, O < O �,Q O -n m
o Z Ovz m r-
Z _4 z z O > m m 2
2 �' p z z Z7 z Z
m z rn z m -
A c m O m 0 m C
-I , o � , z C F �^
2 O -0 m c) cm . m m ;I \
71 Z OAv, OX O X
m p < v, oZ 0 m NO
p O y m � tnT
-1 0 G, -1 D m m 0 X vpm > v, L
m -, Cn c•-4 T_ { Z7 K z D '� c a
(n 6 Cn 3 5 xQ'y--' Z y D m > m m�il Ti
w 2 < z _. , D m m a
N w 0 v, m �, o D m D n O
w m 77 { ? m
2ZoZ
� mzz i O nn v o m v �
Z O K r� n 0gx WI > VI I D � 4(r�
•
C p Z �� Z > O � < m il
CO Is
rill
7 - AM 0 -4 w O D D Ym �ppn zO COZym � I�i1y O
x mm -I >xo v rmn a -mi V71)
o z .! a V o
* momi 1
li 9 ,--II 44nz N.,-3 c f O
ii rig m z w
0