Loading...
HomeMy WebLinkAboutBLD2023-00095 - BLD CD Environmental Health Review - 1/24/2023 �s.:01'' r1M;t,,4t MASON COUNTY COMMUNITY SERVICES Permit No:0L.1c2i0 G- OOI 6 PERMIT ASSISTANCE CENTER: �-tip P�. .�, .1: •BUILDING •PLANNING •PUBLIC HEALTH•FIRE MARS lr:(E. �,.,...- E�; Z � �� 1� `` r �: •1 (4 • p 615 W.Alder Street,Shelton,WA 98584 � _ Ow\ � ,:.. ( ) o 2 4 •t;:," �`► � ,��,��' Phone Shelton: 360 427-9670 ext. 352 Fax (360)427-7798 Ph v w �` �� N Belfair:(360)275-4467•Phone Elma:(360)482-5269 "J•JUNO der Stre \4 BUILDING PERMIT APPLIIaAFi&I PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME:Jeanne Ballot&Kevin Millison NAME:Harrison Homes LLC MAILING ADDRESS:7926 Lake View Lane MAILING ADDRESS:PO Box 385 CITY:Mercer Island STATE:WA ZIP:98040 CITY:Gig Harbor STATE:WA ZIP:98335 PHONE#1:206-291-5528 PHONE:253-851-1117 CELL: PHONE#2: EMAIL :kari@harrhomes.com EMAIL:jballot@yahoo.com L&I REG#HARRIHL02101 EXP. 09282024 PRIMARY CONTACT: OWNER❑ CONTRACTOR 0 OTHER Er NAME Regina Lange,William Zimmerman Architects EMAIL rlange@wzarch.com MAILING ADDRESS 1703 NW 201st CITY Shoreline STATE WA ZIP 98177 PHONE CELL 206-303-0908 PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) 222145000004 ZONING Rural Residential 5(RR5) LEGAL DESCRIPTION (Abbreviated) Lars Olsen Tracts TR4&T.L. FIRE DISTRICT Nonh Mnnon R.genel Fire Authonry SITE ADDRESS 16561 a State Route 106 CITY Belfair DIRECTIONS TO SITE ADDRESS From Shelton,north on Highway 101 turn right on Highway 106 to site address on left. IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO 0 SNOW LOAD:25 psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF ❑ STREAM 0 TYPE OF WORK: NEW El ADDITION ❑ ALTERATION 0 REPAIR ❑ OTHER 0 USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)Single Family Residence IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 3 HEATED STRUCTURE? YES(Whole Bldg) 0 YES (Part[s]of Bldg) 0 NO 0 DESCRIBE WORK Demo(e)building and build a new SF Residence within the existing foot print with detached(unheated)Garage. SQUARE FOOTAGE: (proposed) 1ST FLOOR 1868.8 sq. ft. 2ND FLOOR 814.7 sq. ft. 3RD FLOOR sq. ft. BASEMENT sq.ft. DECK 981.0 sq. ft. COVERED DECK sq. ft. STORAGE sq. ft. OTHER sq. ft. GARAGE 565.7 sq.ft. Attached 0 Detached 0 CARPORT sq. ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER 0 / NEW 0 EXISTING 0 PLUMBING IN STRUCTURE? YES 0 NO 0 If yes, attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT. EXISTING BEDROOMS 3 PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3 OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below. I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON / COUNTY CODE 14.08.42) X ��OJ� I/7--072-0Z 3 Signature of OWNER(Must be signed by the OWNER) Date 1 DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH V 'flee izezi aild,.1iCts acidui 111 al 151:a 14� o 21$2. QQA i9s y .000 ur+ur ¢A T ØPIfiI -kitiEat I AAA € R . IcJ483R 8 i R° Z 1r o8 =a 0 74. III $£Z $$y --� m 'g- __ aF s —��� 7 ,.FAys YWS rE VgJ Ill: it 1 1TT l',4gie4. I -__ t1 a I I 7€ �.° •coa •'I C�I II r t -T`L r1414 14 a„ f � v o >2; ^I obi II Z y • Hit 4 h I p, 2, N SS -J 9 Y "Z 1 III A zrnvr }- v,c T • e+t� f i °P I � o a _ `\ YT �ji 'i'I �� li 2 060 In ` n�vr ��I 1. d + F.T r: —I :,4 • 1L_ - i=====1 •• i t-1,. Irani I EI° a o 3 W - JJ.. _1� •-1_;___,III M W0qV 6e ^ a _D O 4' II I q' ideflOP. • — /� O. `Q III 1 I d O 1 1 �. m 7l ql ��_Ja=� ,,, ao 3 I ig �� a� I ® Io =�2.a N R u. ' ;r Y�ps�ol� I X; *R4 z aj4 as 3 ,i ' _ ilk vo w ` _ _ : ——JSa.I_31 .. a c „4. :71 p. _. . . .16.=..,..i.,.=.. . .8.,.. ii .2, , , Q ..,i L..1 hi .410*Ai 22•N II 111M r i '-,... iii Fr ---- ♦ -� I i �` _ _ -- -- -------- m o o 1 y g Z 1 oM :Ap<'r 1 °m a ovEalEAoeo++Fn _ -.•t GRAVEL PARKING AREA overueno nowEn o D � � pp 111$! EDGE OF PAVEMENT m O o " N., m _- - STATE ROUT 108 LS 0 94 24 —2 �1 Jr .b' A•.-- �y 1 1 �!)- q 1 �_I I — 1 1 ' 1 1 vo D 1 A I MILLISON BALLOT \\Il,:...1 z•I,,I X SITE PLANCO t II 16561RESIDENCE E State Route 106 Belfair,WA 98528 61-Pac3,3 •� MASON COUNTY (�r \ 7 r r.� 415 N 6TH STREET,SHELTON,WA 98584 +--v i/ SHE SHELTON, EXT 400 COMMUNITY SERVICE r� BELFAIR:380-275.4467,EXT 400 C .,� ., JAN 2 4 2a2; ELMA 380-482-6269,EXT 400 FAX:360-427-7787 615W. Alder Street ENVIRONI,1ENTAL On-Site Sewage System SW©2020-00065 HEAL i H APPLICANT JEANNE BALLOT Phone: 206-291-5528 Address: 7926 LAKE VIEW LANE MERCER ISLAND, WA 98040 OWNER JEANNE BALLOT Phone: 206-291-5528 Address: 7926 LAKE VIEW LANE MERCER ISLAND, WA 98040 SEPTIC DESIGNER Jim Henry Design Phone: 360-507-1267 Address: PO Box 14531 TUMWATER,WA 98511 Site Address: 16561 E STATE ROUTE 106 Primary Parcel Number: 222145000004 Permit Description: tank only,blobanier TLA Permit Submitted Date: 02/24/2020 Permit Issued Date: 03/18/2020 Issued By: Rhonda Thompson Current Permit Fees Paid: 5225.00 (additional fees may be required upon Installation of system). Permit Expiration Date: 03/18/2021 (based on date of Inspection) Permit Conditions: 1 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 2 Drainfield installation not to exceed designed upslope and downslope depth specified on design form. 3 Installer is responsible for obtaining Mason County installation approval prior to backfill of system components. 4 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to backfill of system components. 5 Mason County Asbullt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 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 DESIGN APPROVED. FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES. For Final Inspection,cell 360-427-9670,exbenslon 400. Printed From Mason County DMA Printed from Mason County DMS i OFFICIAL USE ONLY MASON COUNTY a —a - � y ill ,COMMUNITY SERVICESAMOUNT R �S� "` "E°� o m #I ScHsaI h(Communky Health/Environmental Health) N mmaa e . t 3o or ,7s.,4a7..xt4 DATE fIED:NEIJ SWG a� o z di ON—SITE SEWAGE TANK ONLY APPLICATION 3 11 m APPLICANT• PHONE r JEANNE BALLOT 206-291-5528 r MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE m 7926 LAKE VIEW LN, MERCER ISLAND, WA 98040 O co 0 x m SITE ADDRESS-STREET,CITY,ZIP CODE Z I 16561 E STATE ROUTE 106, BELFAIR, WA N - NAME OF DESIGNER PHONE I N JIM HENRY 360-507-1267 -1 NAME OF INSTALLER PHONE a I fV TYPE OF WORK(select one) DRINKING NMTER SOURCE O • NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT © PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z 14k COMPONENT(S)TO BE REPLACED/INSTALLED CIPUBLIC WATER SYSTEM , • SEPTIC TANK MI PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE I I 1 • OTHER TANK WITH TREATMENT UNIT 3 .88 ACRES nr OTHER DETAILS(select an the!apply) TANK(S)SETBACK CHECKUST n I O i ❑ SURFACING SEWAGE 0 EXISTING FAILURE a SHORELINE CI100FT+PUBLIC/COMMUNITY WELLS T` I O SUBMITTALS • SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS • PLOT PLAN(REQUIRED) •TANK CROSS SECTION(REQUIRED) • 10FT+DRINKING WATER SUPPLY LINES I O ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) ❑ 5FT+PROPERTY/EASEMENT LINES.FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST r I O III PROPERTY LINES AND EASEMENTS • EXISTING/PROPOSED STRUCTURES • EXISTING/PROPOSED OSS COMPONENTS AND LINES • WELLS WITHIN 100FT •WATER SUPPLY LINES • DRIVEWAYS/PARKING •SURFACE WATERS,STREAMS,RIVERS,ETC... I O IN DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS ■ NORTH ARROW ■SCALE BAR I DIRECTIONS TO SITE AND SITE CONDITIONS-(ex.locked pate) From Shelton, north on Highway 101 to right on Highway 106 to site address on left. i GO V N OFFICIAL USE ONLY BELOW THIS LINE I i � UPGRADE I FAILURE SOURCE(for reporting purposes) 1 '-7 „' ❑VOLUNTARY 0 MAINTENANCE/PUMPING BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER: COMMENTS/CONDITIONS 1 nn5 I a.Adb - -A- SEWAGE TANKS MUST BE USTED UNDER DOH'UST OF REGISTERED SEWAGE TANKS'.TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED WITH RISERS AND UDS 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 bfirOle 311 J7o 3►tbli3 werve4,01 3 /ilsb . THIs FORM MAY BE1SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12///2015 Printed From Mason County DMS Printed from Mason County DMS SING /aunoo Lids' .n a 06 $fiul d N t.t. w Y If cl w cx �° Q w Q J to '' (..,. ��u MZM 3 w w \% N w - { ig t I C tig=2 ay 2m > 0.1 8 L 8 m E 1 {^II I 1 + 2. il m� 4 ;E o H f a i § L I 0 U o 9 g OVm S 8 8 s Q = I I_ W W O = o ��// oo rc w LL W� 0. 1 a o Q 6 tI og H Mg 00 il 31— , i 11 a t . y ✓ Z O H J m N. .1. Z P Z Z od HWY 10Q 2 4?: ` I U v d s `f as g ° ce ui 99.9T p p u co w i < yy{ w N 0 o � 450 FT2 RESERVE AREA i (� 3 Z `L p z rA Z O N 0 ` J f �• t Wp 0 ± B / } ry • z _ q �/ _ w ft i "9,,,,,- 1\i b gix . 8 _ - 0-T . N 53 " ) = CTo m . R - � o _ ®11 a 0 L 8 L J A I— LA ieI= = _ 6 ra -r r O� EO '� •'' rim 41 m LSD U o iliZ (D— O OW O. mZ J- 0 z E tali' w 044 5 ciZ o�m s LLO yc OC W ' .3, 02 C <LL t o g LL<l < 2 W W w Z .. lh Cm C k w U O Ik QQrr Jpi' 0 0 < a �� O a o U • xO 2i R Z 0 w OZ _- &1 �„' �� �a w O U rn YfR ° o� s8 g 55. �S < OF 9 , 2-s �m4 .s£ ` 2 oc m z< w < , °= Eb $ g! g� $ 2 O m UO o < `3 i"- t m F 0, p 2 O 0 ;E o c. 4 !° 211, a � u O h ; a 3� S' 6E2 mE.c m% � �QEl iI 0 z a 2 EF wOBw u b p: am � _ -! Yg od d41 IN''21 1- q0. 1bRoz 0,9, 1.6 2 Ag; ?of pg Q la 11r7LiLL1 7 F 8 U li 8 Y w r. S d O U =W> d< W= F 4.m 8_t000 00 x l W Sec° 8 o 2 Oo � aft iU .. v� 4 eli I t c ° m .4 E, m \�ncZn Ow , ,I, w s 8� °- ia 2 2 0 j<d<°'.- Z_Z "' w §�P €m � � E (� m z ��x ,.; <w z^�EI Uu i- Prinfied From ,�, ,. sou ® k14.,,6 S <3 0 . --..,< Printed from Mason County DMS