HomeMy WebLinkAboutSWG2023-00246 TANK ONLY - SWG Application / Design - 6/13/2023 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: SWG2023-00246
APPLICANT KILFOYLE ET VIR JACOB R Phone: 808.216.0034
Address: 67-237 KIAPOKO ST. UNIT A WAIALUA, HI 96791
OWNER KILFOYLE ET VIR JACOB R Phone: 808.216.0034
Address: 67-237 KIAPOKO ST. UNIT A WAIALUA, HI 96791
SEPTIC DESIGNER DALE TAHJA- Septic Designer Phone: 360-426-5940
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: 4580 E STATE ROUTE 106
Primary Parcel Number: 322314200101
Permit Description: Add septic and pump tank
Permit Submitted Date: 06/13/2023
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)
I
Type of Work OSS New Construction
Components being Replaced: Septic and Pump Tanks
Surfacing Sewage? No Existing Failure? No
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Public Water System
Additional Details: Septic and pump tank
Permit Conditions:
6 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.
5 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
1 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
3 Drainfield installation not to exceed designed upslope and downslope depth specified on
design form.
4 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
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
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DATE RECEIVED:
MASON COUNTY /(t 2j 2�j cn a
COMMUNITY SERVICES AA"Dt' ECE16� RECEIVED BY:Public Health(CommunlryHealth/Environmental Health)0
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360<27�1670,ert.4U0 a 360-2 75�46).ext.400 J G �`,J X3 OO r o 29
115 N.61h Sveet-Shelton,WA 9e584 V�' l/ l J KJ
ON-SITE SEWAGE TANK ONLY APPLICATION %
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APPLICANT PHONE m
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Jacob Kilfoyle (808) 216-0034 z
1 MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 3
67-237 Kiapoko St. Unit A, Waialua, HI 96791 CO
SITE ADDRESS-STREET,CITY,ZIP CODE ��� l% 1 I ..
il 4580 E State Rt. 106, Union, WA 98592 11�Q1 L
NAME OF DESIGNER PHONE 3
Dale L. Tahja (360) 426-5940 By:___NAME OF INSTALLER PHONE v
To be determined <
TYPE OF WORK(select one) DRINKING WATER SOURCE N
O
® NEW CONSTRUCTION I UPGRADES 0 REPAIR I REPLACEMENT 0 PRIVATE INDIVIDUAL WELL Q PRIVATE TWO-PARTY WELL Z +i'
COMPONENT(S)TO BE REPLACED/INSTALLED ill PUBLIC WATER SYSTEM :T1 ...J 1I ,
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TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE
0 OTHER �`Jl� \ S G\C�� W
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST O
❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE U 100FT+PUBLIC/COMMUNITY WELLS 0
SUBMITTALS III SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
10
IN PLOT PLAN(REQUIRED) ®TANK CROSS SECTION(REQUIRED) 1OFT+DRINKING WATER SUPPLY LINES
111 PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) ® ` +PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
r IPLOT PLAN CHECKLIST O
® PROPERTY LINES AND EASEMENTS ® EXISTING/PROPOSED STRUCTURES ®EXISTING/PROPOSED OSS COMPONENTS AND LINES —I
® WELLS WITHIN 100FT II WATER SUPPLY LINES ® DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... C>
® DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS • NORTH ARROW ■ SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) +w� P
Go west out of Union on State Rt. 106, turn left at 4590 E. State Rt. 106. Go through • ,,,=,,��- . 0-6
up paved driveway past house on the left, continue up the hill to the site. �!-�,cS Q V �
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.04. , (4.6.1„ 3:7 r•ic, —.Cli.
•OFFICIAL USE ONLY BELOWTHIS LINE .`%• •,j . i, Qp Z. y
UPGRADE/FAILURE SOURCE(tor reporting purposes) 4‘C%
0 VOLUNTARY 0 MAINTENANCE/PUMPING El BUILDING PERMIT [(HOME SALE ❑COMPLAINT 0 OTHER: `%'- t),
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COMMENTS/CONDITIONS a ,1
\/(\ krA \ tO1---(, tT f‘A"e tocc--
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 APPLICATION APPROVED/ISSUED BY DATE
( (2'74 Y'') c (z747,-3
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED laT/2015
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`DZSIGN FORM-PAGE ONE RECE , c► t
999
'**sips ill be reviewed when&swig of*sob of the following lbws are submitted: r •; 1.1..,
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it f - I♦ f Designees Name: or .0/4 I. ' s
Permit Nrinber: Designer's Phone f t: .. i • ' •i'
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'llseariB»d Length
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a� Length J U N 2 2 2023 4. �
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(bavelloss Chambers Required? ErYes 0 No CrOptiosat Dosbigend Pulp Chamber
Pimp Required? Yea 0 No Number D of Doses/Day —ntity '!0 tog
Purnp/Sloteen SpecNleatbns C'irrsberCapadly /0 0 0 ni
Mature in Elevation Between Pomp Shutoff and Uppermott Pump Controlc Timer fed Elapse Time Meter order required)
Or16ce ,. -11 If Timer: Pomp On ,Pump Off
Uppermost Orifice is Q Higher, glower than Pump Shutoff Check the following components if they drain between doses:
22=e?Toed PramHeed: —La'3.1 �Latlersls ( 'Manifold 0'Dinsport
ow Promo Heed: -.g&T.9 s
()Web Pump ) r
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Media Gallery X
Liberty Pumps 280 - 1/2 HP Cast Iron Submersible Sump/Effluent Pump (Non-
Automatic)
Performance Curve: 280-Series
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APPROVED
JUN222023
MASON COUNTY ENVIRONMENTAL HEALTH
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