HomeMy WebLinkAboutSWG2021-00577 RV HOLDING TANK - SWG Application / Design / As-Built - 10/18/2021 MASON CO U N TY 415 N 6TH STREET, SHELTON,WA 98584
SHELTON: 360-427-9670, EXT 400
BELFAIR:360-275-4467, EXT 400
r Public Health & Human Services ELMA:360-482-5269, EXT 400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2021-00577
OWNER RECHNITZ MICHAEL & LINDSAY Phone:
Address: 15548 SE 175TH CT RENTON, WA 98058
APPLICANT RECHNITZ MICHAEL & LINDSAY Phone:
Address: 15548 SE 175TH CT RENTON, WA 98058
SEPTIC INSTALLER JAMIE WORKMAN-Workman Phone: 360-463-9573
Construction LLC
Address: 120 E TIMBERLAKE DR SHELTON, WA 98584
Site Address: 530 E Lakeshore Dr W
Primary Parcel Number: 220185000021
Permit Description: RV holding tank
Permit Submitted Date: 10/18/2021
Permit Issued Date:
Issued By: David Anderson
Current Permit Fees Paid: $230.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 10/18/2024 (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: 1 Drinking Water Source: Public Water System
Additional Details: Infiltrator 1530
Permit Conditions:
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
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: masoncountywa.gov/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY - --
MASON COUNTY PUBLIC HEALTH DATE RECEIVED:
1C�—fig — l
ONSITE SEWAGE SYSTEM APPLICATION AMOUN,TLREI RECEIVE R - o u)
415 N 6th Street,(Bldg 8) Shelton WA,98584 y ' C N
Shelton:360-427-9670 ext 400 Belfair:360-275-4467 ext 400 S\/ G \( ) ` _ 0_ O
VV O 73
�jJ Z 6
PHONE �v S 1
APPLICANT 1
Jamie Workman mlcV(4,,, , ?�hr�R Z 360 463 9573 m
�^ m
MAILING ADDRESS-STREET.CI .STATE.ZIP CODE RF- J1O�J �v e r
O E Timbe ea (SS�f 8 SE l�Srk C.T� — A �8584 -
SITE ADDRESS-STREET.CITY.71P CODE 3 W
1 530 E. Lakeshore Drive W. Shelton WA 98584 C M
NAME OF DESIGNER PHONE I N
CD
NAME OF INSTALLER
PHONE Cn N
I Jamie Workman 360-463-9573
CHECK ALL APPLICABLE ITEMS DRINKING WATER SOURCE 9 O
C II� (n NEW CONSTRUCTION Er HOLDING TANK ONLY 0 PRIVATE INDIVIDUAL WELL —1
❑ REPLACEMENT SYSTEM 0 INSTALLATION PERMIT ONLY ❑ PRIVATE TWO-PARTY WELL Z
❑ TABLE 9 REPAIR 0 SINGLE FAMILY le COMMUNITY/PUBLIC WATER SYSTEM OD
le TANK(S)ONLY 0 COMMERCIAL SYSTEM NAME: +T.1A.- ,,,.,,n 1
❑ UPGRADE TO EXISTING 0 OTHER: BEDROOMS LOT SIZE I
(31
❑ EXISTING FAILURE "Record Drawing required CO I
for all Installations" r C)I DIRECTIONS TO SITE-BE SPECIFIC AND ADVISE OF ANY NEEDED INFORMATION FOR ACCESS lex.locked gate) 0
Pull into Timberlake (Timberlake Drive), then take the 1st road on the right (E. Lakeshore L I o
Drive W.), follow it down for approximately 3/4 of a mile and look for 530 on the right. It has I o
a new hog wire fence adjacent to the road.
o I
N.) IN
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS I —L
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
pl11IE ? F �
OCT 18 2021
J
By "
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS
INSP R SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED BY DATE
7/Zo4 z3 10/13/b0(I
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
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To: Mason County Community Services
Environmental Review of OSS Application
RE: RV Holding Tank: Pumping
Date: 7/14/2023
To whom it may concern,
I, Michael Rechnitz, property owner of 530 E Lakeshore DR W, Parcel Number 220185000021, do
hereby agree to have the installed RV Holding Tank pumped as necessary, and at a minimum once
annually, as is required for installation of RV Holding Tanks.
Please do not hesitate to contact me with any questions or concerns.
Michael P. Rechnitz
(805) 585-0546
mrechnitz@gmail.com
Property Owner
e4PPRO
Y
JUL 19 2023
MASON COUNTY ENVIRONMENTAL HEALTH
DJA
Holding Tank Sewage Systems-Recommended Standards and Guidance
Effective Date:July 1,2021
Introduction
A Holding Tank Sewage System (HTSS) is an alternative to a conventional on-site sewage
system with very special and limited applications. Simply, the HTSS provides a means to collect
and temporarily store sewage from a facility or dwelling, for subsequent removal and transport to
an approved treatment and disposal site. Depending upon the facility served or the particular set
of circumstances surrounding the use of a HTSS, the expense of sewage pumping,hauling, and
disposal at an approved facility can be very costly, especially on a long-term basis. In addition,
the potential for operational/management problems with resulting public exposure to raw sewage
is significant. For this reason, use of a HTSS must be closely regulated by the local health
agency.
A HTSS is an on-site sewage system that incorporates a holding tank,the services of a sewage
pumper/hauler, and the off-site treatment and disposal of the sewage generated at the site served
by the HTSS.
Figure 1. Longitudinal-Section of Typical Holding Tank Sewage System.
(36I Warning Light and
Audible Alarm
Access Riser with secured Pumping Access Port with
gas tight lid i sloped concrete pad
Inlet �d ��,
from
structure = T
IClnlet APPROVED
- PiPe Reserve Storage Volume
JUL 1 9 2023
st-- MASON COUNTY ENVIRONMENTAL HEALTH
Normal Operating Volume DJA
1 �1
*Septic tanks with plugged outlets are not allowed.Tank must not have an outlet.
DOH 337-006 Page 6 of 17
Audio/Visual
Tank Alarm.
Reinforced
24" structural
/--
access port
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530 E. Lakeshor Drive W. APPROVED"
4 RV Holding Tank Section
JUL 1 9 2023
MASON COUNTY ENVIRONMENTAL HEALTH
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JUL182023 U
By=-
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AppROVED
101. 19 2023 2168950 MASON CO WA
10/1R/2021 10:07 NOTCE
MASON COUNT ENDJA MENTAL HEAL RECHNITZ t1166766 Rec Fee: $203.50 Pages 1
1 III IIIII IN III III 1 IN ill IU IIII I MIIIII IV(III 111DI
Return to:
IMIGKA+E4qEG44.4...1IR
. WILES se- l t
gstirv,0, LOA- q Cc
NOTICE TO FUTURE PROPERTY OWNERS
OF RECREATIONAL USE OF HOLDING TANK
i (We).the undersigned.hereby place this notice on record that the following described real estate situated in Mason
County.State of Washington; to wit: (Division and Lot Number or Range'Township,'Section Number. Note:
Range. township,section numbers arc the l"5 digits or the parcel number)
/I mfbailAims I 2 t OR
sumoicion Division 1.01 Range lomilsitip Section
and having the Tax Parcel Number of:2.2_D j $ --,r o -- D QQ 2,...J
has a holding tank installed on this lot titr sewage disposal liar recreational use only. The approval and permits of the
holding tank was conditional to the mitigation required by the state and county waiver process. Failure to maintain
the holding tank in the manner required by Mason County Public I lealth is a violation of these conditions under
which the holding tank permit was issued.This could result in abandonment of the holding tank and vacating the
property until such lime another suitable method of sewage disposal is appro‘cd.
Dated 1,ND this day of �EY[Vie415e,t.. 'bZl•
Mic.t•tP,C.l_. e 12 xutrj- G
Signature
Signature Pt.,%LAC, IJrQ►t-3rFS-
State of Washington 1
County ot'Mason l
I.the undersigned .a Notary Public in and lur the atm\e t an ed County and State,do hereby certify that on this
� day of Sell MR b-fir .'02( . I Chatj (,y1rL,i-t" ' personally appeared before me,
4 who is known to he signer ofthc above instrument,and acknowledged that he(she)(they)signed it.
GHVFN under my hand and official seal the day and year last above writle .
„se, isICA ,a, ota Public n and for the State Pf Washington.
.••r 11842�''•��'''•, residing at Q003 LtA
.'e`: "L� 1.
My commission expires (t/�12 2A
i' O' PtRY
E - N:
s %; PUBS-�O p,s1:
MN1II
RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH
PARCEL IDENTIFICATION /
Permit Number SWG 2-O2.\— tj0 —)1 Assessor Parcel # ZZ O1'3S0000 2 1
Applicant Name frk tccAE_- k-- ECt,kVc ..Z- Subdivision (Name/Div/Block/Lot)
Applicant Address (S t+8 'C-____ U?S W cr
City, State, Zip ►...)rny,-1 I WA- NO66 Installer Name Jamie Workman
Site Address 530 E. Lakeshore Drive W. Designer Name
INSTALLATION CHECKLIST
❑ Full System Installation 0 Tank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type RV Holding Tank Pretreatment Type
>5 ft. from foundation? - - ❑ N/A 0 YES ❑ NO
>50 ft. from wells? - - ❑ 0 ❑
Z• >50 ft. from surface water? - - ❑ E ❑
< Cleanout between building and tank? - - ❑ 0 ❑
I U Tank baffles present? - - 0 ❑ ❑
P 24" access risers over each compartment?- - ❑ 0 ❑
W Effluent filter installed?- - 0 ❑ ❑
N Infiltration Water Tech.
Septic tank size 1500 gal Manufacturer
Ci D-box water level and speed levelers used? - - ❑x N/A Li YES ❑ NO
Ox0 Manifold/D-box accessible from surface?- - E ❑ ❑
co 2 Check valves installed? - - 0 ❑ ❑
thQ
5 Transport Line Size Schedule/Class SS.:.3S
Bedrooms installed (check one) ❑ 2 ❑ 3 ❑ 4 ❑ 5 ❑6 ❑x Commercial/Other
>10 ft. from foundation? - - ❑ N/A ❑ YES ❑ NO
0 >100 ft. from wells?- - ❑ ❑ ❑
W >100 ft. from surface water? - - CI ❑
Er_ >10 ft. from potable water lines?- - ❑ ❑ ❑
Z > 5 ft. from property lines and easements?- - ❑ ❑ ❑
Q CI ❑ ❑
IlY > 30 ft. from downgradient curtain/foundation drains? - -
Drainfield level and observation ports present - - ❑ ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ❑ ❑
Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES ❑ NO
• Pump tank size gal Manufacturer
< 24" access riser(s) and accessible from surface?- - ❑ ❑ ❑
~ Alarm or Control Panel Installed? - - ❑ ❑ ❑
a
2 Control Panel equipped with Timer/ ETM / Counter- - ❑ ❑ ❑
m
4. Pump installed in ❑ Bucket or ❑ On pm G.40VED
d Pump Make/Model ❑ Floats or ❑ Transducer
M J 1 9 2023
a
Tank draw down in/min Pump capa€l�- gpm Squirt Height ft
Pump on time PIAIRMIirtiV ENVIRONMENTAL HEALTH Daily flow set at gpd
WA Updated 12'7 2015
MCPH RECORD DRAWING (ASBUILT) pg. 2 Assessor Parcel #
RECORD DRAWING
❑ Drainfield&manifold
orientation&layout
w/dimensions for
re-location.
Driveway
❑ Trench/bed
dimensions and fll
critical distances
i . ,
within layout rn N pp 1-
0
Po
❑ Septic/pump tank CD
placementrn
�O O O
= v o v' .� (D
0 Location of buildings a oIt I
existing/proposed ? (n w O 0
3 w
w 7-• 3
Li Observation ports, so = w G
clean-out locations, g),
&manifolds/d-boxes E 744 V it VIci
°' Con1QC&C 1 re -
❑ Location of wells, 5k1.
surface water,roads. 7/ $/2023 Oh
&waterlines. �
❑ Reserve area(s) fa/ rep'��(e,1/ 5 rpI t� Ptcf?
❑ North Arrow tdQ( 7'? '/70
If the designer or installer feel the need for additional information/comments, it may be attached.
Record drawing may also be on a seperate page attached. No. Pages Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
I certify that I installed the system in accordance with I certify that the system has been installed in accor-
the septic design stamped "APPROVED"by Mason dance with the septic design stamped "APPROVED"by
County Public Health and that any deviations shown Mason County Public Health and that any deviations
here have been cleared/approved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
% Lb, 10 - if-Z0Zi
Signature of Installer Date
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH APPROVED
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Pu 1 9 7)23
Health: MASON COUNTY ENVJ--7/ /7 d A NMENTAL HEALTF
Sig ature of Environmental Health Specialist Date (designer's stamp. signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 12'72015