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HomeMy WebLinkAboutSWG2023-00213 - SWG Application / Design - 5/31/2023 MASON COUNTY 415 N 6TH STREET,SHELTON, ,E 98584 T SHELTON:360 427-9679670 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: SWG2023-00213 APPLICANT TOWNSEND NATHANIEL JR & Phone: REBECCA Address: 60 E LEAF LN SHELTON, WA 98584 SEPTIC INSTALLER THAD BAMFORD- Bamford Septic Phone: 360-790-2364 Repair Address: 301 WALLACE KNEELAND BLVD STE 224-332 SHELTON, WA 98584 Site Address: 60 E Leaf Ln Primary Parcel Number: 120185000014 Permit Description: Replace pump tank Permit Submitted Date: 05/31/2023 Permit Issued Date: 06/05/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). 4 Permit Expiration Date: 06/05/2024 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Pump Tank Only Surfacing Sewage? No Existing Failure? No Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 3 Drinking Water Source: Private Well/Spring Additional Details: Pump tank replacement Permit Conditions: 1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval 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. 2 Permit must be installed by a Mason County Certified Installer unless prior written © authorization from Mason County is obtained. Mason County Public Health requires a septic system easement for final approval of septic tank permit. Septic system spans adjacent parcel to the north 120185000013. 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 MASON COUNTY DATE RECEIVED L'� ,�� ��� , COMMUNITY SERVICES R RECEIVED CO (inCI) oco Public Health(Community Health/Environmental Health) A Q fn 4 5 41(50 Str.ext.400 or n.S A 48584 exC 40f: S W + ( 0 0 2, ( O 0 4'S Y.Eth Stree'.Snrlton,'.YA 9P584 rV- Q_�) ���\\\///��j_ z ui ON-SITE SEWAGE TANK ONLY APPLICATION > APPUC N ^ PH E qo-S 5 m r �'J I /c��u nJ.s�-r✓ � Ux z C MAILING ADDRESS- TREE',CITY,STATE.ZIP CODE M m xi SITE ADDRESS-STREET,CITY,ZIP CODE NAME OF DESIGNER PHONE .N\ NAME OF INSTALLER PHO E '-----&241 1 ir4r1 .3 R. TYPE OF WORK(select one) DRIN ING WATER SOURCE 7 NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z I (13 COMPONENT(S)TO BE REPLACED INSTALLED PUBLIC WATER SYSTEM ❑ SEPTIC TANK PUMP TANK 0 RV HOLDING TANK BEDROOMS 3 LOT SIZE n 3OA ❑ OTHER n ' (/II 92 I r OTHER DETAILS(soled all that apply) TANK(S)SETBACK CHECKLIST 0 ❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE ❑ 100FT+PUBLIC/COMMUNITY WELLS n r SUBMITTALS CI50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS A X Io PLOT PLAN(REQUIRED) TANK CROSS SECTION(REQUIRED) ❑{ 10FT+DRINKING WATER SUPPLY LINES I �❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) ql 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS.FOOTINGS PLOT PLAN CHECKLIST r 10 K PROPERTY LINES AND EASEMENTS lif EXISTING/yPRROPOSED STRUCTURES ii EXISTING/PROPOSED OSS COMPONENTS AND LINES —1 I El WELLS WELLS WITHIN 100FT 0 WATER SUPPLY LINES L bRIVEWAYS/PARKING .61 SURFACE ATERS,STREAMS,RIVERS,ETC... ~ XI DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS NORTH ARROW kr SCALE BAR DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked go o t o p i itiwfvbin 461 ( 151 dca Li5-le'fv) �I5r � 4 �zod l6,6 OFFICIAL USE ONLY BELOWTHIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:COMMENTS/CONDITIONS I:Il lJ^ �5 Q MAY 31 2023 �U I n ( cuyv�� P a r ,� f -1-) 1, SEWAGE TANKS MUST BE LISTED UNDER DCH`LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZE REQUI N ,EAIIIP.j;'ED-M)ZRISERS AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINALAPPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED'ISSUED BY DATE (577.q ��NexrTCsm 6(S1L3 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 1217,'2015 1 • r . : vn6s. i io % 1 1 '4' . y �‘- ‘11\ 1 . 1.. 1$70SuaP *124% . ESERv_=_le 5Art•Ear) tovE , _ + � I io - " -'-4- i17.SwPE i PP •• . .71 t2:emu p II ittit9oRT 1..114E Mason County De t. P Health Services 1 APPROVED ii--2.4-rs Initials Date --_____ I i r . • ,d 1 I • I 1 S1rE Foa. 3 BO&,'. ►bgtg e pr^P Ni*Me6il SEvn c TA41, L. I. 1 • ____3'44T_ Pt,A*l PG. I a F % I =10' r 0 —It* Printed From Mason County DMS Printed from Mason County DMS E 1 AS-BUILT FORM - PAGE TWO Revia.d 12/14/94 r I PARCEL IDENTIFICATION i! r I Applicant's Name i leCIL}o.}Cj�n0) Par 144.4Tou.., ,. se , I Permit Number SWG9 4 - t(4" I Subdivision S(q,✓- ci - S (01 I? ,,II 1 `1 iName/Divlslon/Diock/Lot) ;caller's Name gUS 4: \1 t Cs,vn"1't\A Assessor's Parcel No. 126i QC—OOQOI 3 -ner's Name DU.'te)� T ‘ }or-N (Twelve-Digit Number) III _ r AS-BUILT DRAWING 7C1 -‘,1 o To 2, Y'b C r� q r I o' I I ioils.�o , \#7A .SU-0001 14 i 12 rz Z3. • • I I v r 3' 9cM� i�pw_ To R cot' .. /03 , Q `'►' "'=- s4e f . AL\L 1 1 r?u—p ,_, .._ ____________ ,.,.) 'pia),p, 1) i-\12._. \y•-.,- .L.a,,.c.ut46- i,u_7. -iit,,ii 140 . f6 8' 1 °y • v1o1q2)-So-0o0 I L t-v3E CAUTION: Minor adjustments to septic tank location and drainfield orientation wade in the field by the instiller are generally ac- ceptable to both the department and the designer, but could in certain cases cop promise the viability of the oyster. It is the installer's responsibility to obtain prior written approval from either the health department or the designer before making any deviations from the design that affect system viability. Any deviations from the approved design must be shown above. I AS-BUILT CHECKLIST r r r St V Drainfield orientation Observation port location Undisturbed native soil and layout between trenches 71 Cleanout location Trench/bed dimensions and r��� U North arrow critical distances within `71if Manifold placement - layout 0 Scale of drawing shown Orifice placement on scale bar D-Box/"T"/"L" location iLateral placement, with Additional Mound Information Septic tank/pump chamber distances to edge of bed Rti'S location .",,c--1 Le4Endslope width t-�1IJ Location of wells, roads Locatio? bilt. ul , -,,,.., a.y t r f� Overall fill dimensions /I! ,;'',^d `,om Mason County DMS' 1250P & 1250P-HW (!*i.:17)) 1275 GAL. FLOOD CAP. h.. 89 ►.1 68" L TOP VIEW 24" 18" 62" f 4" 6" 1 L_ _I_L f 3• 6- PVC PORT 24' ORENCO TAM( ADAPTER + \ MASTIC CAST-A-SEAL GASKETTIT NI A iT 4•• 22.36 GALS. PER/INCH 64" 51 ' 4•• 3" v v 1 - 1 2- 1 /2" � f'- t f APPROX. WEIGHT 1 1 ,000 LBS.