HomeMy WebLinkAboutSWG2023-00277 - SWG Application / Design - 6/27/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
�ftl BELFAIR:360-275-4467,EXT 400
11 �� 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
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/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
MASON COUNTY DATE RECEIVED -Lc
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ON-SITE SEWAGE TANK ONLY APPLICATION
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APPLICANT PHONE
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE E
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SITE ADDRESS-STREET,CITY,ZIP CODE
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NAME OF DESIGNER PHONE Ilk)
NAME OF INSTALLER PHONE 0
Maples Excava-tinq Np0-y-ce - Nit, N,
TYPE OF WORK(select one) DRIN�KI G WATER SOURCE O
❑ NEW CONSTRUCTION/UPGRADES REPAIR I REPLACEMENT PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z I%'
COMJPONENT(S)TO BE REPLACED/INSTALLED ❑ PUBLIC WATER SYSTEM I
Id SEPTIC TANK 0 PUMP TANK ❑RV HOLDING TANK BEDROOMS //�� LOT SIZE y
❑ OTHER 4- I o l("
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST 0 r
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❑ SURFACING SEWAGE EXISTING FAILURE ❑SHORELINE c(100FT+PUBLIC/COMMUNITY WELLS n 1
0
SUBM ALS I•5OFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
p PLOT PLAN(REQUIRED) EITANK CROSS SECTION(REQUIRED) /10FT+DRINKING WATER SUPPLY LINES
❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST 0 lc ,
❑ PROPERTY LINES AND EASEMENTS ❑ EXISTING/PROPOSED STRUCTURES ❑ EXISTING/PROPOSED OSS COMPCNENTS AND LINES
❑ WELLS WITHIN 100FT 0 WATER SUPPLY LINES ❑ DRIVEWAYS/PARKING ❑SURFACE WATERS,STREAMS,RIVERS,ETC...
❑ DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS 0 NORTH ARROW ❑ SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) - � ' r br�/ll I'O y� �n /'
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OFFICIAL USE ONLY BELOW THIS LINE gY___.^_ _.._`_�
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UPGRADE I FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY MAINTENANCE/PUMPING [IBUILDING PERMIT ['HOME SALE ❑COMPLAINT ❑OTHER:
COMMENTS/CONDITIONS /�
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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
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
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JUN 2 8 2023
83' — MASONI,COUN1Y ENVIRONMENTAL HEALT!
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WATER LINE 41111111117Art
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END ELEVATION
NOTE: DIMENSIONS AND VOLUMES ARE NOMINAL
I" = 25.44MM
SEPTIC 'SUPERTANK' DATE: FEB 2017
• ....N` SCALE: NTS
PICENUER DOUBLE CHAMBER
DRAWN: JZ
P L(A 5 T I C 5 SHEET. No. I OF 2
US. MODEL STSUI300EH - 13000S GAL
www.premierplastics.com 1-800-661-4473 REV. FEB 2019
22" 22"
100"
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4' DEEP RIBS i
TRIANGULAR RIB CONSTRUCTION
ACROSS BASE 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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APPROVED
JUN 2 8 2023
SECTION se MASON COUNTY ENVIRGNMENTAL HEALTH
NOTE: DIMENSIONS AND VOLUMES ARE NOMINAL RET
I" = 25.44MM
SEPTIC 'SUPERTANK' DATE: JUNE 2010
PREI1i1IER DOUBLE CHAMBER
SCALE: NTS
DRAWN: SGM
P L/A S 1 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 (44
JUN 2 8 2023
MASON COUNTY ENVIRONMENTAL HEALTL "
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