HomeMy WebLinkAboutSWG2023-00172 - SWG Application / Design - 5/4/2023 •
MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2023-00172
APPLICANT CHAMBERS THOMAS C Phone: 206-669-5250
Address: 5377 SE ARCADIA RD SHELTON, WA 98584
OWNER CHAMBERS THOMAS C Phone: 206-669-5250
Address: 5377 SE ARCADIA RD SHELTON, WA 98584
SEPTIC INSTALLER BUCKY MANKE-Manke Excavating LLC Phone: 360-490-0791
Address: 1909 PATTERSON SHELTON, WA 98584
Site Address: 1900 SE ARCADIA RD
Primary Parcel Number: 320275005001
Permit Description: Replace septic tank
Permit Submitted Date: 05/04/2023
Permit Issued Date: 05/09/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/08/2024 (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? No
Number of Bedrooms: 3 Drinking Water Source: Private Well/Spring
Additional Details: Septic tank
Permit Conditions:
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
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.
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 C -C-
MASON COUNTY 3 l 9 / a'�2�j c
0
COMMUNITY SERVICESAMOUNT RECENED:
Public CO cn
CO
Public HWth(Community Heahh/Environmental Health)
36D+27-%74 rot IWb)6P275 M67,ezc 400 SWG 0,f3 ,,o
_ ^ Va15 N.6th Street-SAcitrr�WA� SWV �\)Y/v\\ y 2 Z W
ON-SITE SEWAGE TANK ONLY APPLICATION x.
73
APPLICANT PHONE m n
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a \ C�(\,0sv\b� 9,0 Ce la.Cea -Sa SO Z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE
33"11 S ram_ N_o‘ Skne\ 1 CO
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k StTE o O 5 E-STREET,CITY.
L-.\c- P_d SV\eA,- D C� 0 L�
NAME OF DESIGNER PHONE — MAY 0 4 2023
11r�1/A' `..J I
NAME OF INSTALLER PHONE By---____�Fr\ 1 O
vswici i7 WM { JJI �t • y `VA•
N
TYPE OF WORK!select one) / DRINKING WATER SOURCE 'r
ri
❑NEW CONSTRUCTION/UPGRADES 2.REPAIR/REPLACEMENT PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL 3
COMPONENT(S)TO BE REPLACED/NYSTALL ED I❑ PUBLIC WATER SYSTEM t
, EPTIC TANK ❑PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE I j
0 OTHER 1^ -J 1`.^J
OTHER DETAILS(select all llwe � 2 e � / �CT v� W I`1 apply TANKS)SETBACK CHECKLIST t
I
O SURFACING SEWAGE EXISTING FAILURE 0 SHORELINE %100FT+PUBLIC/COMMUNITY WELLS Z I
SUBMITTALS SOFT+PRIVATE WELLS.SURFACE WATERS.STREAMS,RIVERS Ie
PLOT PLAN(REQUIRED) TANK CROSS SECTION(REQUIRED) It 10FT+DRINKING WATER SUPPLY UNES /I
0 0 PUMP DETAILS(IF APPLICABLE) WANER(S)(IF APPLICABLE) IA 5FT+PROPERTY!EASEMENT UNES.FOUNDATIONS.FOOTINGS 1
PLOT PLAN CHECKLIST O 10
'r.PROPERTY LINES AND EASEMENTS prEXISTING!PROPOSED STRUCTURES ` EXISTING!PROPOSED OSS COMPONENTS AND UNES 1 Q
WELLS WITHIN 100FT WATER SUPPLY LINES 'DRIVEWAYS/PARKING SURFACE WATERS,STREAMS,RIVERS,ETC... I
DIRECTION OF SLOPE/CONTOURS la PERIMETER/CURTAIN DRAINS NORTH ARROW SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
LG.0 cc ' 01\ -to CDLr\i\ r- UC 5+ eD\cvaS
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY O MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE OCOMPLAINT ❑OTHER:
COMMENTS ICONDITiONS
,\Lbp Ct,Cr2„ Se_41C- Affl \ _
SEWAGE TANKS MUST BE LISTED UNDER DOH 11ST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZE REOIAREME TS,EQUIPPED WITH RISERS
AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(F APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
-3( 9bI24 S/(a/z3
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC YEW ON THE MASON COUNTY INEBSTTE REVISED 12/7/2015
Messages .. 5:06 PM D
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,,'anted From Mason count "�""E'e''T't
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MASON COUNTY HEALTH DEPARTMENT SEWAGE SYSTEM DESIGN
ENVIRONMENTAL HEALTH SECTION t - y � va
3W NORTH 4th STRICT • SHELTON.WA 90584 /0
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CALCULATIONS )•I otnH SHOW Tilt FOt LOWING ITSMtS IN Oat10«lLOtal:
NO 9 rn ed,OOa_...�._..__.. than N1.l1•nW._... A lit:wt./AYl tr.*M'.Or.and •t meMM syrn..•t WIR•Nd o.
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NI.OTARYPU)BLIC e/
I�.�T If-3.4s.,A - ELR N not t,t h.t1.1 iM INatth ).prt•Mnt .yt onub/• tn
the event Mat Ow special Poie t n pronowd by___-. CIO'--____--__.
fa,ls I.)oMrs% as rega.fett by Arttclet VI r,d VI t^. Mason Cot•,tY 1Maf N Nov Calk
S.pnature C.�!-GA
Sou b ,. and sworn betas me this��.dee try Public tomtezZA.ze of Wath.ngton
at . 19/4, resod ng at
AM.M ASSOCt*T/S O. a WA - _.
dms.masoncountywa.gov C.)
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AFTER THE FACT RECORD DRAWNG,pg 2 Assessor Parcel I 3ZO Zi ce) SCE I
RECORD DRAWING - .
'WOrainie♦i A manifold diJ
orianbillon �sr
Wdkneogons*%
re lecaie0 0 Ate "':;7,4' ,/
dimensions and , ._ ._ __ _�___ APPROVED
(Arai distances I -
'Shin layout I VOvittli I MAY 0 9 2023
Location vddiraen. t MASON COUNTY ENVIRONMENTAL fEALTH
sions for RET
tEi Location dbrrhirgs
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a Otxenaion parle.
dean-outim am
8 marioldsld-banes 6;i' :
t►: loceion of odds. /
suds=main&waterlines. sae. VP ( .20 2.0 y[—,›
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If needed drawing may be attadisd on a separate pie No.Pages Attached
CERTIFICATION OF INSTALLATION
DESIGNER/APPROVED OIAM SPECIAUST
I rattily : I.a contained in This document is accurate to my knowledge. The ►g and orrnaik n
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has .; r r; common Io 9 practices.
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;, -, !Pi', , .. arApproved p it Sperm Date
MASON COUNTY PUBLIC HEALTH
This is an after the fact record drawing,which may or may not indude a county inspection. This information is to only
document an existing OSS location and components
Signature of Environmental Health SpedaNst Date
THIS FORM MAY BE SCANNED am AYINU LE FOR RUUC VIEW ON THE MASON COMM VIEB SITE upaase ante
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RET NMENtAL HEALTH
EK ENGINEERING INC. °"' 6/23H1
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DRAFTED BY: 1250 S, 1250 S-T, °m
P.O.BOX 3097 BATTLE GROUND.WA 96604 O.R.N. 1250 P&1250 P—T
PHONE (36() ::7-7688 FAX: (380) 687-7669 SCALE CP
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EK ENGINEERING INC. 6/23/11 >
DRAFTED BY: 1250 S, 1250 S-T
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P.O.SOX 3097 BATTLE GROUND,WA 98604 D.R.N 1250 P & 1250 P-T 41.
PHONE. (360) 687-7668 FAX: (360) 687-7669 SCALE:
NTS HAGERMAN PRE-CAST
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