HomeMy WebLinkAboutSWG2021-00582 TANK ONLY - SWG Application / Design - 10/20/2021 415 N 6TH STREET,SHELTON,WA 98584
MASON COUNTY SHELTON:360-427-9670,EXT 400
3l COMMUNITY SERVICES BELFAIR:360-275-4467,EXT 400
ELMA:360-482-5269,EXT 400
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Budding,PLinniny,Environmental Health Community ticalth FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2021-00582
SEPTIC INSTALLER GOLDY SEPTIC SERVICE LLC Phone: 1.360.490.0649
Address: PO BOX 159 MATLOCK, WA 98560
APPLICANT COOK RALPH & DEANNA M Phone: 360.426.4912
Address: 1591 W KELLY HALL RD MATLOCK, WA 98560
OWNER COOK RALPH & DEANNA M Phone: 360.426.4912
Address: 1591 W KELLY HALL RD MATLOCK, WA 98560
Site Address: 1610 W Kelly Hall Rd
Primary Parcel Number: 621211200000
Permit Description: Septic Tank replacement
Permit Submitted Date: 10/20/2021
Permit Issued Date: 10/22/2021
Issued By: Rhonda Thompson
Current Permit Fees Paid: $230.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 10/22/2022 (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:
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.
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
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: www.co.mason.wa.us/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
/
OFFICIAL USE ONLY
DATE RECEIVED:
MASON COUNTY I 0 - 0 cn cn
COMMUNITY SERVICES AMOUNT E D:G ^ RECEIVEAB
Public Health(Community Health/Environmental Health) SWG C' \)�/'�] N
415N360 6th Street-d(q«n.WA 8584 ext.400 a`� a. L - V V� �Q OT
41 S N.6th Street Shelton.WA 98584 N
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ON-SITE SEWAGE TANK ONLY APPLICATION v
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( PHONE 3670 a cy
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MAILING ADDRESS-STREET,CITY,STATE.ZIP CODE 3
(S?I W. (/('\ 14 ( I ( 114t+ ;je; b,211- Sic cu
SITE ADDRESS-STREET,CITY,ZIP CODE
NAME OF DESIGNER PHONE
NAME OF INSTALLER PHONE I
GG Seri-IC CE4CL c� LC 3GO— -( —C a a IN
TYPE OF WORK(se ea one)
` DRINKING WATER SOURCE
❑ NEW CONSTRUCTION/UPGRADES ®`F2EPAIR/REPLACEMENT r2t,PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z I
COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM t
SEPTIC TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE
❑ OTHER C` vtC Fitt.,-- f 12.43/S Al`J '1k )--- 7 CO
OTHER DETAILS(sated all that apply) TANK(S)SETBACK CHECKLIST b^ t I C
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❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE 5 100FT+PUBLIC/COMMUNITY WELLS X i
SUBMITTALS $ SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS ^
▪PLOT PLAN(REQUIRED) El,TANK CROSS SECTION(REQUIRED) @ 10FT+DRINKING WATER SUPPLY LINES I Il/a
❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) 5FT+PROPERTY/EASEMENT LINES.FOUNDATIONS,FOOTINGS C
Ir PLOT PLAN CHECKLIST O
i_ PROPERTY LINES AND EASEMENTS ,0-EXISTING)PROPOSED STRUCTURES EXISTING/PROPOSED OSS COMPONENTS AND LINES
Q-WELLS WITHIN 100FT ❑'WATER SUPPLY LINES atRIVEWAYS/PARKING {J SURFACE WATERS,STREAMS,RIVERS,ETC... I ^
DIRECTION OF SLOPE/CONTOURS 0-PERIMETER/CURTAIN DRAINS CrNORTH ARROW [3-SCALE BAR I CY
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
4.'t}.(-0 r ,¢c�,.�1t if_ 40t .0 Gv() ,.p jllL, G (( /2) su_�-rf -Flu_ (,.,o->-�
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes) D LI W 1 '1,
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ['COMPLAINT ['OTHER:
COMMENTS/CONDITIONS OCT 2 0 2021
P--Q0 1 _J
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SEWAGE TANKS MUST BE LISTED UNDER DOH-LIST OF REGISTERED SEWAGE TANKS TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED\NTH 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
L - , ("Clkti7 K-intikrom (1,,i,(z l
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 7/9/2019
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APPROVED
OCT 22 2021
viAsos COUNTs{ENVIROOESI kl.RAM
RV
9/22/2020 Septic Tank Drawings-Sound Placement Services L.L.0
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1 200NCSR & 1 200NCSR-HW
cftTLE ROCK•44P
102
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71 "
(� 18" 24" TOP VIEW
T[ 65
4"
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3.,
MASTIC
24 ORENCO TANK ADAPTERS -'''--0%mr•
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4- CAST-A-SEAL GASKET
`"
-0 4- PVC BAFFLE
4"
FLOOD CAP. 965 GALS. FLOOD CAP. 65"
463 GALS.
54" 51 "
30"
I PROVED
2- 1 i2" --] H 3 OCT 22 2021
MASON COUNTY ENVIRONMENTAL HEALTH
APPROX. WEIGHT 1 1 ,000 L3S. RET
https://soundplacementservices.com/septic-tank-drawings.html 1/1
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