HomeMy WebLinkAboutSWG2023-00204 TANK ONLY - SWG Application / Design - 5/24/2023 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: SWG2023-00204
APPLICANT Doug Devlin Phone:
Address: PO Box 367 LILLIWAUP, WA 98555
OWNER OLD FARM LLC THE Phone: 1.360.490.4807
Address: P 0 BOX 367 LILLIWAUP, WA 98555
SEPTIC INSTALLER JOE FASSIO-Joe Fassio Excavating Phone: 360-898-7286
Address: 170 E SPRUCE ST UNION, WA 98592
SEPTIC DESIGNER ANTHONY DEMIERO Phone: 360-877-5200
Address: PO BOX 1174 HOODSPORT, WA 98548
Site Address: UNKNOWN
Primary Parcel Number: 323165000023
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:
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: ma soncountywa.gov/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY ` CIIQ1/436-
MASON COUNTY DATERt`EMED:
5 - 14 - ‘- _3 cn >
COMMUNITY SERVICES AMOUNT RECEIVED: RECEIVED
p • l 1�1+�
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�,, ' Public Health (Community Health/Environmental Health) cn
\�- 366427-96)e,ext 400 or 360.275d467,ext. <
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415 N.6ih St rCM-Shelton,WA 985&7 SWG `ab 23 - O'104 o 2
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ON-SITE SEWAGE TANK ONLY APPLICATION E
APPLICANT PHONE m0
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MAILING ADDRESS-STREET.CITY.STATE,ZIP CODE C
63
P- o . 3ox 367 <;//;tt_Jo dp r�r«, 9$555 W
SITE ADDRESS-STREET CITY,ZIP CODE
MAp I e_ Lo#JV - I0•1
NAME OF DESIGNER�� PHONE 7p
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NAME OF INSTALLER PHONE I W
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TYPE OF WORK(select one) DRINKING WATER SOURCE cn I_
8 NEW CONSTRUCTION/UPGRADES ❑ REPAIR/REPLACEMENT ® PRIVATE INDIVIDUAL WELL alPRIVATE TWO-PARTY WELL z I(G,�`
COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM I
❑ SEPTIC TANK 0 PUMP TANK t1 RV HOLDING TANK BEDROOMS LOT SIZE (�El OTHER 0 O. Ia
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r
❑ SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE 111 100FT+PUBLIC/COMMUNITY WELLS 0 t
SUBMITTALS ElSOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
effl PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) 8 10FT+DRINKING WATER SUPPLY LINES
18❑ PUMP DETAILS(IF APPLICABLE) ® WAIVER(S)(IF APPLICABLE) W 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST 6 10
® PROPERTY LINES AND EASEMENTS ® EXISTING/PROPOSED STRUCTURES ® EXISTING/PROPOSED OSS COMPONENTS AND LINES
® WELLS WITHIN 100FT ®WATER SUPPLY LINES ® DRIVEWAYS!PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... SI I/
ill DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS iii NORTH ARROW $ SCALE BAR (k.)
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) cr 4i t._I, p c us-f)..ov 1 6 J 17c,s 1 1 '/1,'t.a)a v Y n �^/_r' / le...AL
oY1 Stnaa- Lat-le_ -�eI(D ..5 4o u-tc.plG la vie .90 4-04c o-F (mot.11 , Lo can- I.
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OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes) s
❑VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER:
COMMENTS 1 CONDITIONS D (� U C�1 ,
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(`'\1 1y\� 4vr' MAY 2 4 2023
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SEWAGE TANKS MUST BE LISTED UNDER DOH-LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZE R t M E&1ENTS,EOUIPPED 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
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 07/09/2019
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f MASON COUNTY ENVIRONMENTAL 1EALTkI
VET
EK ENGINEERING INC, DATE: 6113111 TANK OETAi 3fvR MODELS
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:
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E K ENGINEERING INC. DATE: 6/13/11 TANK CONSTRUCTION 6 RE-BAR SCHEDULE FOR MODELS
DRAFTED BY: 1500 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: Cn
NTS HAGeRMAN PRE-CAST