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SWG2022-00040 TANK ONLY - SWG Application / Design - 2/2/2022 (2)
MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 F1417 SHELTON:360-427-9670,EXT 400 COMMUNITY SERVICES BELFAIR:360-275-4467,EXT 400 ELMA:360482-5269,EXT400 Building,Planning,Eihnconm¢ntalHavlth,CommunityHealth FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2022-00040 OWNER CORNEHL WALTER H & NANCY S Phone: Address: 631 E ST ANDREWS DR SHELTON, WA 98584 APPLICANT CORNEHL WALTER H & NANCY S Phone: Address: 631 E ST ANDREWS DR SHELTON, WA 98584 SEPTIC INSTALLER DON WOOLLISCROFT B-Line Phone: 360-426-4221 construction Address: 2971 E PHILLIPS LAKE LOOP ROAD SHELTON, WA 98584 Site Address: 631 E ST ANDREWS DR Primary Parcel Number: 321275100259 Permit Description: Replace pump basin Permit Submitted Date: 02/02/2022 Permit Issued Date: 02/23/2022 Issued By: Luke Cencula Current Permit Fees Paid: $240.00 (additional fees may be required upon installation of system). Permit Expiration Date: 02/23/2023 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Pump 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: Pump and pump basin Permit Conditions: 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 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: www.co.mason.wa.us/health/environmental/onsiteloss-inspection-request.php or call: 360-427-9670, extension 400. / OFFICIAL USE ONLY MASON COUNTY DATERECENED: �V AD Ibli CO D COMMUNITY SERVICES AMOligt 0.11 RECEIVEttgew Cn v m Public Health(Community Health/Environmental Health) C r 360427-9670,ext.400 or 360-275 4467,ext.400 SWG 0 - - 415 N.6th Street-Shelton,WA 98584 O z w ON-SITE SEWAGE SYSTEM APPLICATION m APPLICANT PHONE Fm B-LINE CONSTRUCTION 360-426-4221 z c MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE K 2971 E PHILLIPS LAKE LOOP SHELTON WA 98584 m S631ADDRESS E ST ANDREWS DR SHELTON WA 98584 I c' NAME OF DESIGNER PHONE I N NAME OF INSTALLER PHONE I B-LINE CONSTRUCTION 360-426-4221 < IN PERMIT TYPE(select one) DRINKING WATER SOURCE 5 RESIDENTIAL OSS E COMMUNITY OSS Ir_I COMMERCIAL OSS b.PRIVATE INDIVIDUAL WELL I-i.f PRIVATE TWC-PARTY WELL Z I v TYPE OF WORK(select one) IT PUBLIC WATER SYSTEM LAKE LIMBERICK WS f NEW CONSTRUCTION/UPGRADES V REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR 101 SUBMITTALS 0 SURFACING SEWAGE Iii EXISTING FAILURE 0 SHORELINE W `:DESIGN FORM(REQUIRED) 6-!SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r I ETWAIVER(S)(IF APPLICABLE) 2 175'X80' 0 o DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) PUMP BASIN AND NEW PUMP ONLY. PUMPING TO A COMMUNITY DRAINFIELD. I o TAKE FIRST ENTRANCE INTO LAKE LIMERICK. ADDRESS IN ON THE LEFT SIDE OF o N THE STREET. TANK WILL BE SET TOWARDS THE GOLF COURSE. : I c.3T SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY 0 MAINTENANCEJPUMPING 0 BUILDING PERMIT ❑HOME SALE OCOMPLAINT .2 I TIER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS SOIL CODES: RECORD DRAWING AND INSTALLATION REPORT V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/SSUED BY DATE r.,co-.• r5 f 20 Gp� 71Y3114:11-Y a- THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON T MASON COUNTY WEBSIT REVISED 12/7/2015 l./ r ' r Pump Basin with Effluent Pumping Assembly SYSTEMSCIOM S Scale:3/4"=1' Control Panel r Model MECleanout Vent Assembly `tom Model —I Fiberglass Gasketed Lid with / Stainless Steel Bolts PVC Splice Box Model w/Cord Grips 1 C Model Discharge Assembly gid� Model Conduit to Control Ponel +—� - '_ - _ Effluent Discharge Conduit Seal Model Flexible Hose Feld Cut 4" Pipe to Fit i Sanitary Tee r l n la- IC Level Control From Primary Tank-- -c) _ _ •"1Float Assembly (Floats may be \ Arranged to Allow 10" o Model Effluent Drawdown in Primary Tank) Fiberglass Pump Basin Flow Ind mes • '�'• / Model 1 F Field Cut 4" Pipe to Fit - Concrete Anti-flotation Base I / Extend 6" Beyond Basin Inlet Elbow • . 1 Orono()Effluent Pump Model Filter Cartridge Blotut?Pump Vault Model NDW—TD—PB-02 ©2021, Orenco Systems, Inc. Rev. 4.0 (05/21) APPROVED FEB 2 3 2022 ENRONMENTAIH�`�« AASQN COUNTY L VI I i 2G ' i yi ' 1 60' t j 1, — Zo' CQ yN ecf 147 Cewov.64YA'i l 1— ex r s" ,N .'a A. ft 'A^c:ns.. 9 , G I \-- 1 I 1 I e ii� i 11 APPROVED . ,,. I 1 FEB 2 3 2022 i AAS 1 N COUNTY ENVIRONMENTALHEIC LYC L ,...., ....co • 63( ESf' AAhrovs bit- ;