HomeMy WebLinkAboutSWG2023-00233 - SWG Application / Design - 6/9/2023 MASON COUNTY 415 N 6TH STREET,SHELT 98
SHELTON:360 427-9679670,E 400
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: SWG2023-00233
APPLICANT DAHLIN MARY SUE Phone:
Address: P 0 BOX 628 ESTACADA, OR 97023
OWNER DAHLIN MARY SUE Phone:
Address: P 0 BOX 628 ESTACADA, OR 97023
SEPTIC INSTALLER DARIN OGG- Royal Flush Septic Phone: 360-790-3021
Address: PO BOX 1336 HOODSPORT, WA 98548
Site Address: 24242 N US HIGHWAY 101
Primary Parcel Number: 422125104006
Permit Description: Replace septic tank
Permit Submitted Date: 06/09/2023
Permit Issued Date: 06/14/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/14/2024 (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? Yes
Number of Bedrooms: 2 Drinking Water Source: Public Water System
Additional Details: Hagerman 1250 ST
Permit Conditions:
4 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
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.
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County 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/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY —
MASON COUNTY WE RECEIVED: CL O or 1 p�, w D
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ON-SITE SEWAGE TANK ONLY APPLICATION 3
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SITE ADORESS-STREET,CITY,ZIP CODE
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NAME OF DESIGNER P Oe E
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NAME OF INSTALLER PHONE —T I ^,
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TYPE OF WORK(ye/et one) DRINKING WATER SOURCE Ea l '
o NEW CONSTRUCTION/UPGRADES PAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z
COOAPONENT(S)TO BE REPLACED/INSTALLED W PUBUC WATER SYSTEM �G/4) / - ( V`
1LF SEPTIC TANK O PUMP TANK 0 RV HOLDING TANK BEDROOMS e�/ LOT SIZE I 11
❑OTHER r I , 1
OTHER DETAILS wed Lit tl ee etcply) TANK(S)SETBACK CHECKLIST m I '�
O SURFACING SEWAGE %FYLCTING FAILURE 0 SHORELINE OOFT+PUBLIC/COMMUNITY WELLS n L
SUBMITTALS 1°' SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
ElPLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) ITT+DRINKING WATER SUPPLY UNES
0 PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) ,$5FT+PROPERTY/EASEMENT ONES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST r Lc)- 6
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CI PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES 0 EXISTING!PROPOSED OSS COMPONENTS AND ONES O
❑ WELLS WITHIN TOOFT 0 WATER SUPPLY UNES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC.__ IC>
0 DIRECTION OF SLOPE/CONTOURS 0 PERIMETER]CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR �
DIRECTIONS TO SITE AND SITE COMMONS: ex Locked 'V
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— OFFICIAL USE ONLY BELOW THIS LINE
—
I UPGRADE!FAILURE SOURCE(Ior repolll10 purposes)
0 VOLUNTARY 5KhWNTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE OCOMPLAJNT 0OTHER.
ICOMMENTS/COMMONS
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SEWAGE TANKS MUST BE USTED UNDER DOH"1ST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED WITH RISERS
1 AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(F APPLICABLE RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
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THIS now MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE mason COUNTY mamas
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