HomeMy WebLinkAboutSWG2023-00209 TANK ONLY - SWG Application / Design - 5/30/2023 P _
MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670, 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: SWG2023-00209
APPLICANT BRINK PETER M & JULIA K Phone:
Address: 6721 CASCADE AVE GIG HARBOR, WA 98335
OWNER BRINK PETER M & JULIA K Phone:
Address: 6721 CASCADE AVE GIG HARBOR, WA 98335
SEPTIC INSTALLER Brayden Schoening-septic installer Phone: 360-742-2982
Address: 121 W GRIZDALE DRIVE SHELTON, WA 98584
SEPTIC DESIGNER CINDY WAITE-Septic Designer Phone: 3607010205
Address: 80 E PICKERING LANE SHELTON, WA 98584
Site Address: 11511 E State Route 106
Primary Parcel Number: 222302390032
Permit Description: Replace septic tank
Permit Submitted Date: 05/30/2023
Permit Issued Date: 05/31/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/31/2024 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? Yes Horizontal Setbacks Met? No
Number of Bedrooms: 4 Drinking Water Source: Public Water System
Additional Details: Roth 1500g
Permit Conditions:
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
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
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/environmentallonsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
Amu
OFFICIAL USE ONLY LJL.'
DATE RECEIVED:
:""t-t MASON COUNTY Si- 34) • 3 . D
COMMUNITY SERVICES Amoims 4. RECEIVED o m cn
Public Health(Community HealthiEnvlronmental Health) C 0
43 I SN t Street
Spelt00 n3 WA W.400 SWG 2,b i3 - a016
415 N 6th Shelton WA 98584 N o
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31
ON-SITE SEWAGE TANK ONLY APPLICATION
C AI
m n
APPLICANT PHONE II-
ALDERBRI N KLLC
MAILING ADDRESS-STREET,CITY.STATE.ZIP CODE g
6721 CASCADE AVE, GIG HARBOR, WA 98355 m
SITE ADDRESS-STREET.CITY,ZIP CODE
11511 E STATE ROUTE 106, UNION, WA. 98592 I N
NAME OF DESIGNER PHONE I V Al
CINDY WAITE 360-701-0205 I
NAME OF INSTALLER PHONE G I N
SHOENING EXCAVATING LLC 360-742-2982 Zi7i I`:i
TYPE OF WORK(select one) DRINKING WATER SOURCE 0
❑ NEW CONSTRUCTION/UPGRADES • REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL. Z
COMPONENT(S)TO BE REPLACED!INSTALLED 0 PUBLIC WATER SYSTEM__ _ I 1
IIII ❑SEPTIC TANK 0 PUMP TANK RV HOLDING TANK BEDROOMS LOT SIZE I ♦1
❑ OTHER 4 170'X170'X150'X118' w
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r
❑ SURFACING SEWAGE 0 EXISTING FAILURE pi SHORELINE 0 100FT+PUBLIC/COMMUNITY WELLS 0 I 1
SUBMITTALS ❑ SOFT+PRIVATE WELLS,SURFACE WATERS.STREAMS,RIVERS
PLOT PLAN(REQUIRED) TANK CROSS SECTION(REQUIRED) 1OFT+DRINKING WATER SUPPLY LINES I�
❑ PUMP DETAILS(IF APPLICABLE) El WAIVER(S)(IF APPLICABLE) .SFT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST Or-
III PROPERTY LINES AND EASEMENTS • EXISTING/PROPOSED STRUCTURES i EXISTING/PROPOSED OSS COMPONENTS AND LINES —1
• WELLS WITHIN 100FT • WATER SUPPLY LINES ❑ DRIVEWAYS/PARKING ❑SURFACE WATERS,STREAMS.RIVERS,ETC... I -V
S DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS ® NORTH ARROW •SCALE BAR tr
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) I`�
GO NORTH ON BROCKDALE, STAY ON MCREAVY, TURN RIGHT ON DALBY ROAD,
TURN RIGHT ONTO 106, PARCEL IS ON THE WATER SIDE. MAN GATE IS NOT
LOCKED.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY MAINTENANCEA/PUMPING MOULDING PERMIT ['HOME SALE ['COMPLAINT ❑
•
(2 ,'/y.
COMMENTS!CONDITIONS „n,, .ey Q�� SG �O �f G�(/ �/, �(�'l{��q +-p
3C ( . - t-. .
SEWAGE TANKS MUST BE LISTED UNDER DOH-LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS, IPPED 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
•S 'i3 ( I V-( &?\e, -S-I3i(Z"
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
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