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HomeMy WebLinkAboutBLD2023-00778 - BLD CD Environmental Health Review - 5/5/2023 . MASON COUNTY CO�r!y1UNkT, ,5ER CES Permit No:2L.O P0(I�-3` PERMIT ASS/STANCc CEtgq LL [[�JLL33 I` C '"i •BUILDING •PLANN NG •F `P AL R E C E b Z .1 I,. A 615 W. Alder St- She ton.W 13�d� '. _fi 8 ' www.co.mason.wa.us AY _ 5 2023 Phone Shelton: (360)427-9670 ext. 352• Fax: (360)427-779 E�11/ ��_�; Phone Belfair. (360)275 4467• Phone Elma:(360)4822,5" w Alder StrCC*N IRON'MENTAL PLUMBING & MECHANICAL PERMIT APPLICATION HEALTH AL OWNER INFOR ATI 7 CONTRACTOR INFORMATION: NAME: q yy) K.ybi }).SO NAME: ,jQmP I S ©L(1 ,-Y-- MAILING ADDRESS: Sb S _ 4 ralte t; k4 MAILING ADDRESS: CITY:-SJ 1-f`0t.- STATE:\,C ZIPS54 '5g CITY: STATE: ZIP: 1st PHONE: ,3(0,-') -7 L1 — LI J (Q) PHONE: CELL: 2'PHONE: EMAIL : EMAIL: �Lh tti li •�yin ; L&I REG# EXP. / / cs.'7svnrs PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number): ,e. c G q ` ) 3 aQ?j 0) Zoning: LEGAL DESCRIPTION(Abbreviated): SITE ADDRESS: _SC) SF, -ArL.c\d,1 Q\ R�, CITY: Stl -`0 yli }Ot DIRECTIONS TO SITE ADDRESS: 1 t Eel 3+ 0 V) A rulckl k cl IJ '/- r'Qp 1 X Ce �` a TYPE OF JOB: NEW ADDI IALT1 I REPAIR) I OTHER USE OF BUILDING LOCATION OF FIX URES/UNITS— 1ST FLOORI 12ND FLOOR) I BASEMENT I I GARAGE) I OTHER PLUMBING FIXTURES(SI-IOW NUMBER OF EACH) MECHANICAL UNITS Type of Fixture No.of Fixtures Fees Fuel Type:Eiectri.KIIl PG1 _Natural Gas) IDuctlessEl Toilets ) Type of Unit No.of Units Fees Bathroom Sink i Furnace Bath Tubs Heat Pump Showers I Spot Vent Fan j _ Water Heater 1 Propane Tank Clothes Washer 1 Gas Outlets Kitchen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hose bibs 1 Dryer Vent _ Other mopf Solar Panel 'Si") Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER acknowledge submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection.This permit/application becomes null&void i if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OFTHIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS ILL I ALIDATE THE APPLICATION. X 1a �\ K076-4/h4.-(7-'Th 5``� �� ' 1iS gnature of Ownet ate DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL • Lrlvt*re1Aertlot 11Calfk of Rev:Va�c7 i3 o40(b°84(' bt,Oaoa3--0O77 0514 , 9 ENVIRONMENTAL } HEALTH I RECEIVED - -- F,qN C� MAY - 5 2023 615 W. Alder Street APPROVED \ S J U L 2 8 2023 MASON COUNTY ENVIRONMENTAL HEALTF DJA e)t.0&oR3 -01D-77F3 ' lilib 5E Mile t-thU ljnve I�SPECTRA Laboratories-KitsaP Port Orchard,WA 98366 _ . wzvw.spectra lab.com_wu,.ew.,,.,,., .,:, (360)443-7845 COLIFORM BACTERIA ANALYSIS FORM Date Sample Collected Time Sample County RECEIVED 3 / 9 / 23 Collected 3 50 DAM Mason Month Day Year --m RN Type of Water System(check only one box) MAY - 5 2023 ❑Group A ❑Group 6 paver 615 W. Alder Street Group A and Group B Systems—Provide from Water Facilities Inventory(WFI): I Dlt System Name: Amanda Robinson Contact Person:Arleta Eisele/Arcadia Drilling Day Phone:360-426-3395 Cell Phone: Email: arleta@arcadiadrilling.com Eve.Phone: Send results to:(Print full name,address and z p code or e-mail) [�arleta@arcadiadrilling.com EN` rIRO 1NIENTr — Arcadia Drilling,Inc v HEALTH SAMPLE INFORMATION Sample collected by(name):Seth Specific location where sample collected: Special instructions o come ments: 680 SE Arcadia Rd,Shelton Type of Sample(check only one box) I 1.E]Routine Disfibuhon Sample 2 R epeat Sample(after unsat routine) Chlorinated:Yes❑ No❑ ❑Distribution System Chlorine Residual:Total_Free_ Unsatisfactory routine lab number 3.Source Ground Water Rule Sample _ - _ S I I I Unsatisfactory routine collect date: ❑Triggered Chlorinated:Yes❑ No CI ID Assessment Chlorine Residual:Total_Free 4. Enumeration Source Water Sample ❑E.coil OFecal-Surface.GWI,Springs:Filtered Yes Elfb I S I I I ED 5.0 Sample Collected for Information Only- LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY ❑Unsatisfactory Total Coliform Present and .. , _ /ctory 0 E.colipresent 0 F_.coliabsent �/ `fs+fa Replacement Sample Required: ❑Sample too old(>30 hours) ❑TNTC 0 lacterial Density Results:Total Coliform _J100m1. E.cok____/100m1. Fecal Coliform _ /100m1. HPC /1 ml. ab ID Number Date and Time Received 22- t / , -D2 '1//cJi /6 D ethod Code: Date and Time Incubated: SM 9223 B Ile Analyzed_3 1 ! (/2i...3 Date Reported; )/l(/23 )ri LadS pl Lab Use Only: Frno eur-3tsi Ovid:11ci n.od ekakn n,n rm:;a. 1 n+ma.naur,..,,, ,.,a...,y.a.u,.nv,nr 'anal tag D00575Af77(IOrYTT—cd 7�t). —— n.y:�,..r,.