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HomeMy WebLinkAboutSWG2023-00114 - SWG Application / Design - 3/27/2023 MASON COUNTY 415 N 6TH STREET, SHELTON,WA 98584 • SHELTON:360-427-9670,EXT 400 :If 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: SWG2023-00114 OWNER HUBER LEONARD & SHARON L Phone: Address: 4917 SW MORGAN ST SEATTLE, WA 98136 SEPTIC INSTALLER PATRICK HALL-septic installer Phone: 360-443-2325 Address: 4235 SE MILE HILL DR SUITE B PORT ORCHARD, WA 98366 APPLICANT PATRICK HALL-septic installer Phone: 360-443-2325 Address: 4235 SE MILE HILL DR SUITE B PORT ORCHARD, WA 98366 Site Address: 661 E TREASURE ISLAND DR Primary Parcel Number: 121055200241 Permit Description: Replace septic tank Permit Submitted Date: 03/27/2023 Permit Issued Date: 03/29/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 03/29/2024 (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: Public Water System Additional Details: Hagerman 1000g ST 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. 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. 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: -- MASON COUNTY � �� (TdiT. :: ) COMMUNITY SERVICES goe") AMO r ^ RECEIVED B .lII, pip Cp m Public Health(Community Health/Environmental Health) C c ".0).,,,,,),'} 360 415N.6th Str,e,t:lton,Wor 360]75.<467.ext.400 SWG c .� -13 — 0 V l ( q g 2 61 S N.6th Street•Shelton,WA 98584 O ON-SITE SEWAGE TANK ONLY APPLICATION m C) APPLICANT PHONE m Pat Hall Construction, Inc. 360-908-7357 H z MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE K co 4235 SE Mile Hill Dr., Suite B, Port Orchard, WA 98366 u) m SITE ADDRESS-STREET,CITY,ZIP CODE —s ' CD 661 E Treasure Island Drive, Allyn, WA 98524 _ NAME OF DESIGNER PHONE Q) I N N/A- REPAIR-TANK REPLACEMENT ONLY 0_ NAMEOF INSTALLER PHONE I v Patrick Hall - Pat Hall Construction, Inc 360-908-7357 R I o TYPE OF WORK(select one) DRINKING WATER SOURCE O ❑ NEW CONSTRUCTION/UPGRADES III REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z I al COMPONENT(S)TO BE REPLACED/INSTALLED I] PUBLIC WATER SYSTEM Treasure Island Water System ❑ SEPTIC TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE I Ui 0 OTHER 2 .21AC 03 OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST I- I N I ElSURFACING SEWAGE II EXISTING FAILURE 0 SHORELINE 0 100FT+PUBLIC/COMMUNITY WELLS T�C) I Q SUBMITTALS ❑ SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS ® PLOT PLAN(REQUIRED) I] TANK CROSS SECTION(REQUIRED) 0 10FT+DRINKING WATER SUPPLY LINES I O ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 0 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST O IN ® PROPERTY LINES AND EASEMENTS ® EXISTING/PROPOSED STRUCTURES RI EXISTING/PROPOSED OSS COMPONENTS AND LINES le WELLS WITHIN 100FT ® WATER SUPPLY LINES RI DRIVEWAYS/PARKING ® SURFACE WATERS,STREAMS,RIVERS,ETC... IV ® DIRECTION OF SLOPE/CONTOURS B PERIMETER/CURTAIN DRAINS ® NORTH ARROW IN SCALE BAR -P , I -- DIRECTIONS TO SITE AND SITE CONDITIONS'(ex locked gate) From Grapeview Loop Rd, turn onto Treasure Island Dr. At stop sign at water tower, turn right. go 6/10 of a mile - 661 E. Treasure Island Drive will be on the left. OFFICIAL USE ONLY BELOWTHIS LINE-- UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER: - - tt l 'vq tg\._), COMMENTS/CONDITIO D MAR 27 2023 SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZ qfi 13 IREMENT P AND LIDS TO SURFACE.AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQU 'FlRAL' ROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE (-71.17)— . _ __. A:NQA\IT L°V) q-?Mi-l/a THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/72015 RECORD DRAWING (continued) to a L1zat.sai - SH ,\I jgtQ 1 E fl- si QE �SLArV �R. - ) Z PaRte l.-* 12105-52.601A1 S Cal-e— i `t - 7,o° I- 1 4' . , -_ .� '3v ii) <4.,,, .....$‘'wn-To LI x 1'g Cam --N 'Oi °�p&Ty ud� y6 �` ©p 10 GEvgL ! y v, R_ ! j '4 pp i �s� � �O��V 1 o ( -�"'- �. Q MA s MAR 2 9 2023 S�P� G ' ,s� - ON COP Eh'y�R pNMENtAI HE,q ,0 ►s „_1 REr �rH fo -�•---' �� Of1tn m n -443 O. 91- _ i Je lJo WN - N - 0 ` WN - " T' �Q i ``4D NN SARA Ri a50E yNm t Z Wg Q ! Q} Uu' S Z v ,( F„s CO D Q,N .54i > 5tiT Z 4 = : rn j th VZ] s t7b •5O �O j �cAAz liJ ( O " g , g, I =qs,RNFIQ ➢ 0 AI a oy_ a aQ Ak)or =� E-O Z ny R O: r C pa,, rVv 4P.S g ' , O O plPi. nnN-.AR, m O VZog 4AR? ( . 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