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HomeMy WebLinkAboutSWG2023-00214 TANK ONLY - SWG Application / Design - 5/31/2023 MASON COUNTY 415 N 6TH STREET,SHELTON, 967 ,E 98584 SHELTON:360-427-9670,EXT 400 ri„ BELFAIR:360-275-4467,EXT 400 ,. .�+- �`i f Public Health & Human Services ELMA:360-482-5269, EXT 400 FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2023-00214 OWNER BUNKER STEVE & LINDA Phone: Address: 2401 Olympic Ave NE RENTON, WA 98056 APPLICANT BUNKER STEVE & LINDA Phone: Address: 2401 Olympic Ave NE RENTON, WA 98056 SEPTIC DESIGNER CINDY WAITE-Septic Designer Phone: 3607010205 Address: 80 E PICKERING LANE SHELTON, WA 98584 Site Address: 1028 W LAKESIDE DR Primary Parcel Number: 519015001052 Permit Description: RV holding tank with waiver Permit Submitted Date: 05/31/2023 Permit Issued Date: 06/21/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 06/21/2026 (based on date of inspection) Type of Work OSS New Construction Components being Replaced: RV Holding Tank Surfacing Sewage? No Existing Failure? No Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 0 Drinking Water Source: Public Water System Additional Details: Sound Placement 1250 gallon cement Permit Conditions: 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. 3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. I 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. twiq ------------OFFICIAL USE ONLY "i ----i - ---w) sto 9 DATE RECEIVED: MASON COUNTY 1 s.41• c cn _ .II. COMMUNITY SERVICES Amints REC •i pp �j NI\_ g m (` y Y. Public Health(Community Health/Environmental Health) yyI < cn 360 427.9670,.0 400 or 360.275.4457,ext.400 A ///��� .-.•' 415 N.6thStreet•Shelton,WA 58584 !S`/`'( _ % O � O 2 ON-SITE SEWAGE TANK ONLY APPLICATION m 0 APPLICANT PHONE m r VICTOR HEBERT 206-919-0439 z C MAILING ADDRESS-STREET.CITY,STATE,ZIP CODE E 2401 OLYMPIA AVE NE I m XI SITE ADDRESS-STREET,CITY,ZIP CODE RENTON,WA. 98056 I Cn NAME OF DESIGNER PHONE CINDY WAITE 360-701-0205 NAME OF INSTALLER PHONE / / I CO TBD Lori t4 - c S TYPE OF WORK(select one) DRINKING WATER SOURCE Cl) o ❑ NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT ElW PRIVATE INDIVIDUAL ELL` ❑ PRIVATE TWO-PARTY WELL Z I — COMPONENT(S)TO BE REPLACED/INSTALLED EllPUBLIC WATER SYSTEM ❑ SEPTIC TANK 0 PUMP TANK LE RV HOLDING TANK BEDROOMS LOT SIZE I al ❑ OTHER 0 0 IA,a.c-.. W OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST • 0 ❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE ❑� 100FT+PUBLIC/COMMUNITY WELLS • Z I t0 SUBMITTALS 0 SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS RIVERS I] PLOT PLAN(REQUIRED) I3 TANK CROSS SECTION(REQUIRED) ri1 10FT+DRINKING WATER SUPPLY LINES I ❑ PUMP DETAILS(IF APPLICABLE) © WAIVER(S)(IF APPLICABLE) CI SFT+PROPERTY/EASEMENT LINES,FOUNDATIONS,F OTINGS PLOT PLAN CHECKLIST 0 I O IEl PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES —I ❑ WELLS WITHIN 100FT tEl WATER SUPPLY LINES IR DRIVEWAYS/PARKING tEl SURFACE WATERS,STRWO,R tjS,IVE ETC.,. 1 I CP ❑ DIRECTION OF SLOPE/CONTOURS ElPERIMETER/CURTAIN DRAINS RI NORTH ARROW © SCALE BAR. ' •-) i` DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) I MAY 3 X 2023 i I N I1 Li m _3my.._ --' • •• -- -- — — — — OFFICIAL USE ONLY BELOW THIS LINE---' UPGRADE/FAILURE SOURCE(for repoNng purposes) 1 1 ❑VOLUNTARY 0 MAINTENANCE/PUMPING ElBUILDING PERMIT ['HOME SALE ['COMPLAINT ❑QTHER: COMMENTS/CONDITIONS MA c -31—(4/11,\L— SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUI SPED WITH RISERS AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROJAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE R-14\ertfC6N\ C(7/{( _____... .i THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 07/09/2019 /". ...:.N. . i oimik. No . .. 1:1:;1.'0116111MA 1 i 0 0 ' • •?• fti . ,.. 7 -1-A ry ---.1 --I . 01 0 -0 iG) _a. OD , I-- F-711 CO ! N.) ap LP -r1 1- 01 .. 0 ! 0 0 i'v CD 1.3 1 n > -Li Pci op_ ry 01 CD d'IF rv: 0) 00 APPROVED 1 AIN 2 1 2023 1 i MASON COO FY E4 ViRONMENTAL).1E.ALTt }.RET , 1 i I 1 1 0 1 e 0 q o g isd 0 II h ol fa. ,t•_ . :.tr , • O * % tw it • ' • s•Ord �. ` f ~ 1' I. : A O • 1� 1 \ 3:10.0 o .j„�0' `` O ,�/' — �� 0. VI 4, ,_ ' .. 1 a' Q ....._._. ...,1 ...i \ IL.-., v›.4, 1 7 obi.' i •1 1 2si j `b gir:4,,, C:3\\Nts:', ‘ • 0 77.4 i I D h r ` OVED '� ao J�1N 2 1 2O2j`� N e r , . o ` ASG�ti CGUNr�E4VI,�Oh'.►��N1'AL HEALTH I,n o.., I , �� RET , 9 ' 110 ! i N I c, D U) • � fT1 D a N rn U --- I o w O 0 w rnN III XJ _ - H --� N O 0 • II� > �W VJ � D cn APPROVED i JUN 2 1 2023 MASON COUNTY ENVIRONMENTAL HEALTH RET