HomeMy WebLinkAboutSWG2023-00205 TANK ONLY - SWG Application / Design - 5/24/2023 415 N 6TH STREET, SHELTON,WA 98584
i r�- MASON COUNTY 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: SWG2023-00205
APPLICANT Doug Devlin Phone:
Address: PO Box 307 LILLIWAUP, WA 98555
SEPTIC DESIGNER ANTHONY DEMIERO Phone: 360-877-5200
Address: PO BOX 1174 HOODSPORT, WA 98548
SEPTIC INSTALLER JOE FASSIO-Joe Fassio Excavating Phone: 360-898-7286
Address: 170 E SPRUCE ST UNION, WA 98592
OWNER OLD FARM LLC THE Phone: 1.360.490.4807
Address: P 0 BOX 367 LILLIWAUP, WA 98555
Site Address: UNKNOWN
Primary Parcel Number: 323165000022
Permit Description: RV holding tank with waiver
Permit Submitted Date: 05/24/2023
Permit Issued Date: 06/22/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/22/2026 (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: Private Well/Spring
Additional Details: Holding tank
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/environmental/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY .\-4' g.53PkA'
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,IfrT MASON COUNTY DATE RECEIVED: r �I .1
3 i II• 1'; COMMUNITY SERVICESoviiiiic ai
,c t AMOUN CEIVED: RECEIVED(:
r -^, Public Health(Community Health/Environmental Health)
'•H1pa,‘ 3fi0-427-9670,ezt 460 or 3tie-275-467,exr-400 C
415 N.6th Street-Shelton,WA 98584 SWG
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ON-SITE SEWAGE TANK ONLY APPLICATION D D
APPLICANT m
PHONE Ill m
DCI tic) 4 bet/I;l 366-790 - t 07 P z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE o- C
p o (3a x- 367 L.;/I;tt rJa,aOp 97Sgg
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SITE ADDRESS-STREET,CITY,ZIP CODE RI
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NAME OF DESIGNER
/]�r �^_ ,-_ r n� PHONE
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NAME OF INSTALLER -
j PHONE
L,/} �60- g98-_7 o 6, Iw
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TYPE OF WORK(select one) DRIN G WATER SOURCE
r NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT 0P (n RIVATE INDIVIDUAL WELL in PRIVATE TWO-PARTY WELL Z I
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COMPONENT(S)TO BE REPLACED/INSTALLED
0 PUBLIC WATER SYSTEM
ElSEPTIC TANK 0 PUMP TANK RI RV HOLDING TANK BEDROOMS 1
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❑ OTHER 0ASIZEloi
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OTHER DETAILS(select all that apply) Ill, D �]
TANK(S)SETBACK CHECKLIST V 6
❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE ® 100FT+PUBLIC/COMMUNITY WELLS
SUBMITTALS ® SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
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El PLOT PLAN(REQUIRED) TANK CROSS SECTION(REQUIRED) al 10FT+DRINKING WATER SUPPLY LINES
❑ PUMP DETAILS(IF APPLICABLE) libWAIVER(S)(IF APPLICABLE) Fri 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS le
PLOT PLAN CHECKLIST
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El LINES AND EASEMENTS Et EXISTING/PROPOSED STRUCTURES el EXISTING/PROPOSED OSS COMPONENTS AND LINES
El WELLS WITHIN 100FT ®WATER SUPPLY LINES ® DRIVEWAYS!PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... N IN
iii DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS [l NORTH ARROW la SCALE BAR N
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) le) sJ, d n OS N0)J 10/ e,s-- I;//; pS4,5 1 I N
S Flo,- L4 -. - llo�.J 4-0 17ua plc (o i-►e. 4-0 p 0,' h '/I, {s- a i 1-. �" /et,'�or1
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i 4S8 179:
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OFFICIAL USE ONLY BELOW THIS LINE �yy 212
UPGRnDE/FAILURE SOURCE(for reporting purposes)
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❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE OCOMPLAINT ❑OTHER:
COMMENTS/CONDITIONS
Q-'Q Ale$01)'N( --'--A- 0 ---
SEWAGE TANKS MUST BE LISTED UNDER DOH`LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED 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
A�P{PLICAT�IO/N�AP��PROVEDI ISSUED BY r^� DATE
b (rV1/ ?As `����1 V 00\ rn Coh; l.----
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE
REVISED 07/09/2019
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EKENGINEERING INC, DATE: 6M3111 TANNOETAIW FOR MOOES 71
DRAFTED BY: 1 500 S, 1500 S-T, m
P.O.BOX 3097 BATTLE GROUND,WA 98604 D.R.N. 1500 P & 1500 P-T
PHONE: (360) 687-7668 FAX: (360) 687-7669 SCALE: -A
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E K ENGINEERING INC. DATE:
6/13/11 TANK CONSTRUCTION b REM B 9CN•DUIF FOR MODELS
oRAFTED BY: 1500 S, 1500 S-T, m
1 P.O,BOX 3097 BATTLE GROUND,WA 98604 D.R.N. 1500 P & 1500 P-T
PHONE: (360) 687-7668 FAX: (360) 687-7669 SCALE: CJ7
NTS HAGERMAN PRE CAST
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