HomeMy WebLinkAboutSWG2023-00324 - SWG Application / Design - 8/4/2023 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 Permit: SWG2023-00324
APPLICANT DELANO TYLER C &TARA E Phone:
Address: 41 QUINAULT TRAIL ELMA, WA 98541
OWNER DELANO TYLER C &TARA E Phone:
Address: 41 QUINAULT TRAIL ELMA, WA 98541
SEPTIC DESIGNER CINDY WAITE-Septic Designer Phone: 3607010205
Address: 80 E PICKERING LANE SHELTON, WA 98584
Site Address: 41 W Quinault Trl
Primary Parcel Number: 519175200038
Permit Description: RV holding tank
Permit Submitted Date: 08/04/2023
Permit Issued Date: 08/15/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 08/04/2026 (based on date of inspection)
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 DESIGN APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.govlhealth/environmental/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
" MASON COUNTY DATE RECEIVED:
,I' 0a-T3
,,l COMMUNITY SERVICES AMOUI,T RECFIV ': RR:EIVEDHY. W
cn
Public Health(Community Health/Environmental Health) W.
M
cn
4. , 360-427.9670.est.40C or A60.275-4467 eat.41)1/ C
4 I S N.nth Street-Shelton.WA 98584 ('°\I► G .. x3 N O
ON-SITE SEWAGE TANK ONLY APPLICATION 3
APPLICANT i PHONE. m m
DAVID CARROLL 512-5147-7493 z
MAILING ADDRESS-STREET CITY STATE.ZIP CODE C
r 11
SAME It
SITE ADDRESS-STREET CITY.ZIP CODE ' — ——"-- --- XI
41 W QUINAULT TRAIL, ELMA, WA. 98541 — H,tr, .. u ,rt, 1 I(1
NAME OF DESIGNER PHONE
CINDY WAITE i 360-701-0205 By
NAME OF INSTALLER PHONE
TBD G
TYPE OF WORK(select one) DRINKING WATER SOURCE — - I1
❑ NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z 1-Ni
COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM
❑ SEPTIC TANK 0 PUMP TANK ® RV HOLDING TANK BEDROOMS LOT SI7E k!`'y
❑ OTHER
W (OTHER DETAILS(select all that apply,) TANKS)SETBACK CHECKLIST r
CISURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE El100FT+PUBLIC!COMMUNITY WELLS 0I
SUBMITTALS 0 SOFT+PRIVATE WELLS,SURFACE WATERS.STREAMS.RIVERS X I `:^^
❑ PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) 0 10FT+DRINKING WATER SUPPLY LINES I
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 0 5FT+PROPERTY/EASEMENT LINES.FOUNDATIONS.FOOTINGS
PLOT PLAN CHECKLIST T- IQ.❑ PROPERTY LINES AND EASEMENTS 0 EXISTING!PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES -I El4)10
WELLS WITHIN 100FT 0 WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS.STREAMS.RIVERS.ETC...
❑ DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER!CURTAIN DRAINS ❑ NORTH ARROW ❑ SCALE BAR
DIRECTIONS TO
SITE AND SITE CONDITIONS (ex locked gate; / / / / 1
60 act, C fe 9 LA 4 I.1. i-1, Q t✓ Go `4 74 f 7 A,!"
0 , y
716 we.p& 1s. 5i4e. L (,)-Az /,.1, at"L o Ae J
u%Na,..l.l 7-kcz1. i.1' 0.0 ' A-A .e ) S'Je G -111.1 rioct?,/ .
-- ---- OFFICIAL USE ONLY BELOW THIS LINE-- 11 KCtiA./e e
UPGRADE/FAILURE SOURCE(for reporting purposes) TtcG
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑H'I SA e 'n a y L.�T ;0 E
COMMENTS I CONDITIONS
AUG 15 2023
MAC COUNTY ENVIRONMENTAL HEALTH
H
SEWAGE TANKS MUST BE LISTED UNDER DOH LIST OF REGISTERED SEWAGE TANKS' TANKS MUST MFI' RANIT MINIMUM Sin REQUIREMENTS.EQUIPPED WITH RISERS
AND LIDS TO SURFACE AND INCLUDE AN EFFLUENT FILTER tiF APPLICABLE. RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAI APPROVAL
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION I)AIE APP!. :AT 'N APPROVED/ISSUED BY DATE ,
• 0,-/S z3
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 01109/2019
i
i
3 a. --r ----..
V C5
V
ca
C_ _
04
op
4.3
j 1 C?)-'
P )" N
Cr
/'47 .1 f,')'? tql/4 APPROVE
Mi AUG 15 2023 lij
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
/
M.\
-171A-E347:7-4-
1 200NCP & 1 200NCP-HW
(W
1 /1 7 5 GALS. FLOOD CAP.
11. I 02"
1g , 7 „
TOP VIEW 24"
6 "
4"
1
APPROVE
AUG 1 5 2023
MASON COUNTY ENVIRONMENTAL HEALTH MASTIC ,
6 ; JBW 24 ORENCO TAW ADAPTER
PVC PORT
4- CAST-A GASKET
25.43 GALS. PER/INCH
6 5
5 "
4"
V
I I
2- 1 /2"
3"
APPROX. WEIGHT 4
, 1 ,000 LBS.
David Carroll
31 Meadow Wood Dr
Elma, WA. 98541
8/3/2023
I agree to have my holding tank pumped as needed with a minimum of once annually.
David Carroll
S 1 cj'1 7-- S�3-
I
PPROVE
PI AUG 15 2123
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
I
I
I