HomeMy WebLinkAboutUntitled (1643) MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
- 1 Public Health & Human Services ELMA:360-482-5269,EXT 400
..:..,
FAX: 360-427-7787
On-Site Sewage System Tank Only Permit: SWG2023-00177
APPLICANT JOHNSON MIKAL WALTER Phone:
Address: PO BOX 978 HOODSPORT, WA 98548
OWNER JOHNSON MIKAL WALTER Phone:
Address: PO BOX 978 HOODSPORT, WA 98548
SEPTIC INSTALLER Jerry Upson- MIKKELSEN SEPTIC LLC Phone: 360-480-3571-Jerry
Address: 980 E MIKKELSEN ROAD SHELTON, WA 98584
Site Address: 60 N SKOKOMISH DR
Primary Parcel Number: 423295000210
Permit Description: Replace septic tank
Permit Submitted Date: 05/09/2023
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: 05/09/2024 (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: 3 Drinking Water Source: Public Water System
Additional Details: Sound Placement 1200 gallon cement
Permit Conditions:
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
4 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
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.
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 RECENED:
MASON COUNTY S'9 ' a
cn D
COMMUNITY SERVICES AMOUNT RECENED:^5/� RECENED BY /JCa CA
ct..... C CA
Public Health(Community Health/Environmental Health) C cn
4315 N.6t6 70,Street
•400Shelton,
n,WA 8584 ext.400 S VV G d61,
^ f - ,o /�� Z Cl)
a15 N.6th Street-Shehon,WA 98564 C/�(1
ON-SITE SEWAGE TA K ONLY APPLICATION
APPLICANT O�` PHO m
i' 1' l,lJ tidivicork , (42\ g �j��'� ZS� C
MAILING ADDRESS-STREET,CITY.STATE.ZIP CODE v
PO C50X "11b {--oo1 o 14-<9 A-14•"g4 co
SITE ADDRESS-STREET,CITY,ZIP CODE
-60/t/S/coAcai SA [)f co-
NAME OF DESIGNER t., / h
NAME OF INSTALLER PHO
-60) (-7g O 5-11
TYPE OF WORK(select one) DRINKING WATER SOURCE
❑ NEW CONSTRUCTION/UPGRADES ,W,REPAIR/REPLACEMENT *0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z I'V'
COMPONENT(S)TO BE REPLACED/INSTALLED .PUBLIC WATER SYSTEM t
0 SEPTIC TANK 0 PUMP TANK ❑ RV HOLDING TANK BEDROOMS LOT SIZE I�
❑ OTHER 0 '1 CO IQ3
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r
Q 1
❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE In 100FT+PUBLIC/COMMUNITY WELLS n
SUBMITTALS �SOFT+PRIVATE WELLS.SURFACE WATERS,STREAMS,RIVERS ici),
A PLOT PLAN(REQUIRED) )ILTANK CROSS SECTION(REQUIRED) .® 10FT+DRINKING WATER SUPPLY LINES O
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) , 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS (�`
PLOT PLAN CHECKLIST r I1 v
PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES 0 EXISTING!PROPOSED OSS COMPONENTS AND LINES -I
.,WELLS WTHIN 100FT 0 WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... I—
❑ DIRECTION OF SLOPE/CONTOURS 0 PERIMETER!CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY MAINTENANCE/PUMPING 0 BUILDING PERMIT th,HOME SALE ['COMPLAINT 0 OTHER:
COMMENTS/CONDITIONS
cc2ibecui2, c(A.,,_ -. -,A,A\c--
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
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
. * • ,i_ ,
P.,
9/22/2020 Septic Tank Drawings-Sound Placement Services L.L.0
IS y; 1200NCSR & 1200NCSR HW
cAarke ROCK.Ist,
I'm— - 102"
2 �'
� � I
I � I
71 „
C N 18" 24" TOP VIEW [1 ]
65
4"
L - L_ L ' _
t AF O 1'
3 MAY 0 9 2023
MASON COUNTY ENVIRONMENTAL HEALTF,
RET ►+ASTrc
24" ORENCO TANK ADAPTERS ���
4' CAST-A-SEAL GASKET --I r1,2 --------
1 4 - tiA
-. 4" PVC BAFFLE
4„
I
FLOOD CAP. 965 GALS. C FLOOD CAP. 65"
463 GALS.
54" 51
30"
-JI_ t
2- 1 /2" �l f-
3"
APPROX. WEIGHT 1 1 ,000 L33.
F
/
SITE NO. (p 3 &0 3 - _ PARCEL NO. L
DATE BASIS FOR FEE AMOUNT NUMBER
THURSTON-MASON HEALTH DISTRICT � r
DIVISION OF FNVIRONMENTAL HEALTH 4_f 3_?cp Sd'e_ 4".S e>ae_ 4(`� d XQ1(p
529 WEST FOURTH 110 W.K ST P.O.BOX 746
PHONE 753-8073 PHONE 426-4407
OLYMPIA, WA 98501 J1/� SHELTON, WA 98584
OWNER /cIi -e// �. Yice �Lb' 4 J
P O. NONE DIRECTIONS TO SITE: TOTAL
/3S MI\Q- 0 t• — 9 illn FEES
CONTRACTORSEWAGE r/ ex S -A. CIcu4-coU ccs
LteciAdiett-4-
M� dC/C�f 0` �i lam -
ADDRESST OR •I •
LOCATIONNAMF OF PLAT / NOT. ��D - SOIL TYPE SA<'"svy 4 Y C G[ l-z,�--'1
TOWNSHIP RANGE SEC. p 'At" ^�'� 6 / DEPTH TO ATE TABLE FT.
WATER 0 PUBLIC ❑ PRIVATE PERC. TESTS: INCHES PER HOUR
SOURCETYE OF �L�
BUILD NG /AMP BASEMENT9IO S SIOZE L - X//O BY: DATE
PRIMARY f a� GAL. AERAAT,ION Y GAL.
NO.OF NO.OF GARBAGE SEPTIC TANK lSi
BEDROOMS 3 BATHS DISPOSAL yeso C--7t.kfzs
SPACE RESERVED FOR DISTRIBUTION TILE TAPAL l a.(-idigEenwEFE
REPLACEMENTS DISTRIBUTION FIELD SQ Fl
TRENCH BOTTOM AREA SQ. FEET
4 NORTH • SITE PLAN AND SPECIAL STIPULATIONS:
`� '`r b-4 t° Q I 1 - QUANTITY OF
v4�/Gl Q(�� APPROVED STONE CU. YD. SAND CU. YD.
LIAy i I /'-•rz 1 rT&-�
�+ FILL REQUIRED CU. YDS.
��� e -ee bs%4'1L f
Jr-( � `'csi THE ELEVATION OF THE BUILDING SEWER SHALL BE SUCH THAT
to S G I).TE/lCn'' •AIJ BE-
TWEEN MAXIMUMTHE 2 INCHES AND 36 INCHESRFROM FINISHED GRADE TO
IBUTION TILE SHALL BE d ,� -p TOP OF TILE UNLESS OTHERWISE STIPULATED BY THE HEALTH
„,_ d/T t-,4 `A ' T � OFFICER. IF THE ELEVATION OF THE BUILDING SEWER IS TOO
Q� LOW TO MEET THESE ELEVATIONS,A SEWAGE EJECTOR MAY BE
/ REQUIRED.
�j' ISOLATION STANDARDS FOR PRIVATE WATER SUPPLIES:
Y • BETWEEN WELL AND TANK OR ANY PART OF THE TILE FIELD,
100 FEET FOR SINGLE RESIDENCE, MOBILE HOMES, DUPLEXES
AND MULTIPLE DWELLINGS. NO DRAINFIELD WITHIN 100 FEET
_ OF ANY WELL, FRESH WATER LAKE OR STREAM;100 FEET FROM
ANY SALT WATER BODY.
D}h / . ` ..d"�`47(d �1 NOTE 'FOOTING DRAINAGE, DOWNSPO TS, WATER SOFTENER AND ANY
J} y 1, '1,,,�, (/ euc�� Wsi� OTHER WASTE WATER NOT DEFINED AS SEWAGE SHALL NOT BE CONNECTED
r��� """ J TO OR DISCHARGED INTO THE SEPTIC TANK SYSTEM OR THE SEWAGE DISPOSAL
�. n. . „la,
CONNECTED TOVTHE SEP C LADING SINK AND LAUNDRY WASTE, MUST BE
- FINAL INSPECTION REQUIRED BEFORE BACKFILLING
ONLY TO BE BACKFILLED
AFTER INSPECTION
DATE APPLICANT MUST CALL FOR INSPECTIONS LISTED BELOW 112"TO 24" 1
NOT
SITE: APPROV D 1--1 APPROVED V _ _ (- 2"STRAW
P3Pfx-74 5:';��t•til1 �. •4a•i. �� 1 STONE BY:
n,4! • 1•0.:=,•4.•i��•^ OVER TILE
SEWAGE' ,�°t' APPROVED ❑ NOT 4•..:4i�' 1'1-4•, .,•
//` 7` fJ i` :?.'••�•0,\CS !t•��,•�> FI 1 STONE
NOT Y: •`�;,',1•1 �D' �`?5:1 ' UNDER TILE
{ WATER: 0 APPPPPR�OVED�^} ❑APPROVED
� F
F'I rotes From Mason ou t m 1*--
CROSS SEG`TION OF TRENCH I ®"
F:TintOU from Mason County DMS •
41 N
N o
o
• „s t ' KC VU0 NL.., 0O N O; N cN w, oa w v, Oo M oC3o' 0iI
iv
VI
C CD
N �
g D
A z N G7
ti 0 w
N O (n
o .cri p X
N 3
N
' �¢' AJ 0
T
A
tD C, �" N O
O CIQ co
NJ X
13
, 12 :
o
w al
co
SD
i ,
APPROV 16
MAY 0 ' 023
g MASON COON NVIRONMENTAL •LTR A
z
RETto
wo N $
�o 0
cn
o
A N
0 O O fJ J
O.... N o
Z N
O Ec i
O -I O
•,,O
rnW
r
N
o j
AZ
WA
NX
i!01
cn
1
i
o
o g
71
N rn
o r
A