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HomeMy WebLinkAboutSWG2023-00015 TANK ONLY - SWG Application / Design - 1/25/2023 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:360-482-5269,EXT 400 FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2023-00015 OWNER LANE ALISHA & JEREME Phone: Address: 2123 W HURLEY WALDRIP RD SHELTON, WA 98584 APPLICANT LANE ALISHA & JEREME Phone: Address: 2123 W HURLEY WALDRIP RD SHELTON, WA 98584 SEPTIC INSTALLER TESSA HOLT- Dodge Excavation Phone: 360-349-5333 Address: 4225 BLACK LAKE BLVD SW OLYMPIA, WA 98512 Site Address: 2123 W HURLEY WALDRIP RD Primary Parcel Number: 419257500010 Permit Description: Replace septic tank Permit Submitted Date: 01/25/2023 Permit Issued Date: 01/30/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 01/30/2024 (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? Yes • Number of Bedrooms: 2 Drinking Water Source: Private Well/Spring Additional Details: Sound Placement 1200 gallon cement Permit Conditions: 1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 2 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County 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/onsite/oss-inspection-request.php or call: 360-427-9670, extension 400. I , OFFICIAL USE ONLY /--� DATE RECEIVED: ` I�� I MASON COUNTY / I cn "1 COMMUNITY SERVICES AMOU REf RECEIVED BY: C----A. co cn m 1 Public Health(Community Health/Environmental Health) R. 360-427-9670,ext.400 or 3 60-2 7 5 446 7,ext.400 �^ /t 415 N.6th Street•Sheton.WA 98584 S\/t G J ( ^ �3 - 6 O U ' S 0 J V V OOOCCC...���,JJJ Q _ ON-SITE SEWAGE TANK ONLY APPLICATION D D m C) APPLICANT PHONE m -rlisha d- 3tivaij Lart-e- (tot, ND Rig-7 Z MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE g W )a 4/ m SITE ADDRESS-STREET,CITY. r ' 2 23 w [�t�a.2d�-��� goadgoad �/JI , W9es(1V 4- NAME OF DESIGNER /� PHONE N I, r/ kin NAME OF INSTALLER I e SS I t PHONE Ddcv- Exccwakm (Lc 3 3449 5335 N TYPE OF WORK(select one) DRINKING WATER SOURCE O ❑ NEW CONSTRUCTION/UPGRADES kREPAIR/REPLACEMENT tePRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z I v COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM 1 SEPTIC TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE 3 ❑ OTHER c bCI VDDN'�,Jc G. o uD a c e 03 OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST Q 101 C I ❑ SURFACING SEWAGE )0 EXISTING FAILURE 0 SHORELINE 100FT+PUBLIC!COMMUNITY WELLS SUBMITTALS 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS tSt PLOT PLAN(REQUIRED) TANK CROSS SECTION(REQUIRED) 10FT+DRINKING WATER SUPPLY LINES I C C> 0 ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 5FT+PROPERTY!EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST O I tom, ❑ PROPERTY LINES AND EASEMENTS �] EXISTING/eP�ROPOSED STRUCTURES I EXISTING/PROPOSED OSS COMPONENTS AND LINES WELLS WITHIN 100FT 0 WATER SUPPLY LINES DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... I n CI• DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS NORTH ARROW 0 SCALE BAR DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gale) {aryl, W&k(t,Y,v YUO tit. 40w` let o k; acAd Ye ss 01--- , ILI'‘. . OFFICIAL USE ONLY BELOW THIS LINE UPGRADE!FAILURE SOURCE(tor reporting purposes) T i Illl�u^ 11 0 ` I 0 VOLUNTARY MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE COMPLAINT ❑OTHER; D COMMENTS/CONDITIONS III JA N 2 5 2023 ❑ NVA.C-Q- Cci9C- -Y-6t v\V--- ‘01-6cm,--A-c,0 _pou(\ot 4-0 12.e R--- Liii . `In S GITI S oh,�(}1u-, W 1-10W° 5Nw-By 1 SEWAGE TANKS MUST BE LISTED UNDER DOH"LI�GISTERED 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 -50 / va 4 q-9012.3 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 0 - 'N'-'1•11.,‘ N N V W I 1 N 3 S K n Co v O C v D o o m F . ° D wZ'. SW� G) Z C X rn o v 0 .., .. . , . I, _. , , . .. , . i, s , . 0 v 10 co • •'. Ill 11441414:i' 3 cu 0 { C D t l\ ._ . } a a, to 41ifili'" .. N' GA i 115 N i iel F~ :t ,. er. 4111 ir ©■ O ,, .... U7 A W N f-+ m m - •* - D x x, v, o 5 = - - Q_ W W - 3 o CD `V 3 71 N I. rr) Q �. -oco O�� \ rw rD o, co 'r F• � MENT s /08E5`" 1200NCSR & 1200NCSR-HW ,,, CA8rLE ROCK.V°. 102" -1 F H-I- I 2 I I I I I I I 1 I I I I 71 „ 0118 24" TOP VIEW Lill 3 1 65 4 L L LL _,__ t 3 APPROVED J A N 3 0 2023 /w►sTiC 24 oRENco TAM( AE 1 COUNTY ENVIRONMENTAL NEALk' RET 4 CAST-A-SEAL GASKET --4- PVC BAFFLE 4" 1_ _ FLOOD CAP. 965 GALS. — FLOOD CAP. 65 463 GALS. 54" 5 1 „ 30" • - 1 r 2- 1 /2" H t 3', APPDX. WEIGHT 1 1 ,000 L3S.