HomeMy WebLinkAboutSWG2023-00277 - SWG Application / Design - 6/14/2023 s .
MASON COUNTY 415 N 6TH STREET,SHELTON, .E 98584
SHELTON:360 427-9679670 EXT 400
i f 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: SWG2023-00277
APPLICANT KAMAN K PAUL Phone:
Address: PO BOX 791 SHELTON, WA 98584
OWNER KAMAN K PAUL Phone:
Address: PO BOX 791 SHELTON, WA 98584
SEPTIC INSTALLER Shane Maples- MAPLES EXCAVATING Phone: 360-463-8474
Address: 911 SE Arcadia Road SHELTON, WA 98584
Site Address: 111 W RUSTIC LN
Primary Parcel Number: 420224400010
Permit Description: Replace septic tank
Permit Submitted Date: 06/27/2023
Permit Issued Date: 06/28/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/28/2024 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 4 Drinking Water Source: Private Well/Spring
Additional Details: Premier plastics 1300g
i
Permit Conditions:
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
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.
4 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
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
MASONCOUNTY DATE RECEIVED: cn D
COMMUNITY SERVICES AMOUN EC(\,4�i\� RECEN B: co cn
Public Health(Community Health/Environmental Health) CL v'�' R" rn
7A670,ext.4m or 36PI75a467.ext.40o 415 N. S W G �LJ Z ' - 0 "�1 7 O
(/�415 N.6eh Street-Shelton.WA 98584 Q
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ON-SITE SEWAGE TANK ONLY APPLICATION y D
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APPLICANT PHONE m n
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Ka r 1 Kaman 3(.00-4 - 4-3 r
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MAILING ADDRESS-STREET,CITY,STATE.ZIP CODE 3
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SITE ADDRESS-STREET.CITY,ZIP CODE 71.
111 VIi' RU 'hc Ln- c 1eI tD✓1 (1n1/" °W5gLi I.- -
NAME OF DESIGNER PHONE IN-)
NAME OF INSTALLER PHONE v IC )
Mcpl es Exc�tvatin� 3100-4,u - 9q3\-I N
TYPE OF WORK(select one) DRINKI G WATER SOURCE O
❑ NEW CONSTRUCTION/UPGRADES ['REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z IkN
COM.JPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM
ld SEPTIC TANK ❑PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE
❑ OTHER 4- I Oa& W
OTHER DETAILS(select all that apply)) J TANK(S)SETBACK CHECKLIST r
❑ SURFACING SEWAGE EXISTING FAILURE 0 SHORELINE 11100FT+PUBLIC/COMMUNITY WELLS 0
SUBMALSSOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS 0
si. PLOT PLAN(REQUIRED) GITANK CROSS SECTION(REQUIRED) /10FT+DRINKING WATER SUPPLY LINES I�
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) SFT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS �y
PLOT PLAN CHECKLIST r" I
0
❑ PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES —1
❑ WELLS WITHIN 100FT 0 WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... F.-
0 DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) ,
Fat led -tan k, re/flacti with Fit rnlex plas-1t,C tN400 gall On septic
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i,]'Li 2023 JUN27 .,(;I
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OFFICIAL USE ONLY BELOW THIS LINE gY1_
UPGRADE/FAILURE SOURCE(for reporting purposes) 3
❑VOLUNTARY MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT 0 OTHER:
COMMENTS/CONDITIONS D ,9
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
((-1 I2i y61/1 '6 P56r c
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12n/2015
100•
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/, el FILTER
• ••D. •.I .1 • ACCESS
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IN OUT CENTRELINE
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SLOT FOR
PLAN VIEW PARTITION WAA ^ ^R O` ,E D
JUN 28 2023
B3 MASC1N COUNTY ENVIRONMENTAL HEALTH
_ �� RET
WATER LINE C
41
6
IIL 1
END ELEVATION
NOTE: DIMENSIONS AND VOLUMES ARE NOMINAL
I" = 25.44MM
SEPTIC 'SUPERTANK' DATE: FEB 2017
PR.EER DOUBLE CHAMBER
SCALE: NTS
DRAWN: JZ
P L(A S TICS SHEET. No. I OF 2
US. MODEL STSUI300EH - 1300US GAL
www.premierplastics.com 1-800-661-4473 REV. FEB 2019
22" 22"
100' ►
i ttlyy
I t
SAIA
4" DEEP RIBS J TRIANGULAR RIB CONSTRUCTION �-^,
ACROSS BASE J ELIMINATES "ACCORDIAN' EFFECT 10'
UNDER PRESSURE
ELEVATION
RIBBED ACCESS
COVER 24"
4" SPIGOT NOM. OPENING 4" SPIGOT
FOR RUBBER INSPECTION PORT LIFTING EYE FILTER ACCESS FOR RUBBER
CONNECTOR CONNECTOR
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LIQUID � p � �_
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OM _1_ pli_ OUT
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1
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FRICTION FIT
s PIPE CONNECTION r I
'0 > CONNECTION 4"0 PVC ?
z MAY VARY % F
0
1— i I i" RIGID PLASTIC -4
%�— DIVIDING WALL
,co"1 I Ilk e A
J U N 28 2023
39"
SECTION MASON COUNTY ENVIRONMENTAL HEALTH
NOTE: DIMENSIONS AND VOLUMES ARE NOMINAL RET
1" = 25.44MM
SEPTIC 'SUPERTANK' DATE: JUNE 2010
1 PREER DOUBLE CHAMBER SCALE: NTS
DRAWN: SGM
P L(A S T I C S USA MODEL STSUI300EH - 1300 US GAL SHEET. No. 2 OF 2
www.premierplastics.com 1-800-661-4473 REV. FEB 2019
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APPROVED
JUN 2 8 2023
MASON COUNT' EYr1RONYEtiTA!HEA!Ti
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