HomeMy WebLinkAboutSWG2023-00323 TANK ONLY - SWG Application / Design - 8/4/2023 1
MASON COUNTY 415 N 6TH STREET,TEL WA 98584
SHELTON:360-427-9670,EXT 400
R. ,
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: SWG2023-00323
APPLICANT JOHN STEWART Phone: 1.360.790.1673
Address: 88 N TILLICUM BEACH LN SHELTON, WA 98584
OWNER JOHN STEWART Phone: 1.360.790.1673
Address: 88 N TILLICUM BEACH LN SHELTON, WA 98584
SEPTIC DESIGNER CINDY WAITE-Septic Designer Phone: 3607010205
Address: 80 E PICKERING LANE SHELTON, WA 98584
Site Address: 88 N Tillicum Beach Ln
Primary Parcel Number: 422265000001
Permit Description: Tank Only
Permit Submitted Date: 08/04/2023
Permit Issued Date: 08/30/2023
Issued By: David Anderson
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)
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? No
Shoreline? Yes Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Public Water System
Additional Details: 1250SR
Permit Conditions:
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
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.
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.
PiL
AUG 0 71013 OFFICIAL USE ONLY
spat ^�r'c MASON C•UN + DATE RECEIVED:
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ON-SITE SEWAGE TANK ONLY APPLICATION D D
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JOHN STEWART
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SAILING ADDRESS-STREET.CITY.STATE.ZIP CODE — C
88 N TILLICUM BEACH LANE, SHELTON, WA. 98584
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SITE ADDRESS-STREET.CITY.ZIP CODE Rl
SAME I"
NAME OF DESIGNER t
PHONE
CINDY WAITE 360-701-0205 N
NAME OF INSTALLER
TBD PHONE v I ^/
TYPE OF WORK(select one) I 1 '
DRINKING WATER SOURCE fn
❑ NEW CONSTRUCTION/UPGRADES ® REPAIR/REPLACEMENT ❑ PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL z
Z I,
COMPONENT(S)TO BE REPLACED'INSTALLED ❑' PUBLIC WATER SYSTEM TILICUM BEACH WS
® SEPTIC TANK ❑PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE
❑ OTHER 2
22'X82' rA I
OTHER DETAILS(select all that apply) r
TgNKI S;SETBACK CHECKLIST
❑ SURFACING SEWAGE 0 EXISTING FAILURE la SHORELINE ❑
® 100FT+PUBLIC/COMMUNITY WELLS 0
SUBMITTALS ■ 50FT+PRIVATE WELLS.SURFACE WATERS.STREAMS,RIVERS I I O
® PLOT PLAN(REQUIRED) ®TANK CROSS SECTION(REQUIRED) ❑ 10FT+DRINKING WATER SUPPLY LINES
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) ❑ SFT+PROPERTY/EASEMENT LINES.FOUNDATIONS.FOOTINGS I
PLOT PLAN CHECKLIST
T—
I] PROPERTY LINES AND EASEMENTS ® EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES -1
❑ WELLS WITHIN 100FT 111 WATER SUPPLY LINES ❑ DRIVEWAYS/PARKING I SURFACE WATERS.STREAMS,RIVERS.ETC...
❑ DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS �NORTH ARROW II!SCALE BAR I`
DIRECTIONS TO SITE AND SITE CONDITIONS:lex locked gate)
GO NORTH ON STATE HIGHWAY 101, TURN RIGHT INTO TILLICUM BEACH,
RESIDENCE IS STRAIGHT AHEAD NEXT TO COMMUNITY DOCK/AREA ON THE LEFT
SIDE OF THE ROAD. IT IS ON HOOD CANAL.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reportmq purposes)
0 VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT OHOME SALE OCOMPLAINT ❑OTHER:
COMMENTS.CONDITIONS
SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS. TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS.EQUIPPED WITH RISERS 1A AND LIDS TO SURFACE.AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL.
INSPECT SIGNATURE DATE APPLICATION EXPIRATION DATE
APPLICATION APPROVED.'ISSUED B" DATE
8/04,az3 52((-1/zo
705 THI FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE 2
REVISED 127I2015
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MASON
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AEG 3 0 2023
u ENVI
DJq AL HEALTH
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fipsa"'"••,,, 1250SR & 1250SR-HW
C4TLf ROCK V1► APPROVED
AUG 302023
MASON COUNTY ENVIRONMENTAL HEALTH
l'"' 116" DJA
. ---- _- 72" -- ,...- 36" 1
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24" TOP VIEW
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24. ORENCO TANK ADAPTERS MASTIC
4' CAST-A-SEAL GASKET
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•c1 4. PVC BAFFLE 4 1
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4. LP
rL000 CAP. 1036 GALS. F504OOD CAGALS.
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64"
55. 1 /2
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1 52- 1 /2'
30'
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APPROX. WEIGHT 1 1 ,000 LBS.
PIIIPIIIPI"'"".-
• THuRa`'TO DIVISION OF SANITA I Court Hsu a Armes'
poo, Court House Annex A UG 3 p 2023 (rlympia, aehingtcm
Shelton,
Washington Phones 3'2-�+851'F.3one s LICATIO MASON CO�UTN, RQRSCEDISPO6AL5Y'TEMAPPLICATION TO CONSTRUCT �"�"" ti on) \-:
ire i r Each n "taL�
(Application Requ �-^
.f Telephone_. 1 '- "� d
Property Omer i
ease P. lit Addrese of site C OM'
Mailing110110 Address dinipL lf�Block _�_ _ ,
Location of Props y, nc u g: I.
(Detailed directions to site) , .4• , '
c�nmsrcial 1
Z Basement Type Ii✓o
'roper y Bedrooms
Size . .-5 .1 , �� Residence (./ No.
Water 5upp y: Public F r�( Spring der No
Is any water supply or body-of water withinlfeet of sewage sy3 em2
SKETCH PLANS AS DESIGNATED ON BACK SIDE OF THIS SHEET. 1t
r
Septic Tank? gallons. Drainage System Length�� feet. Trench Wi• ih
III! F.H.A.: Yes No.
And/Or other __
Check for Installation ofr/ Garbage Grinder ( ). }
Automatic Laundry ( , Automatic Dishwasher ( ),
Ie Contractor installing septic tank? Yes l No
Drainfield? Yee �No
Name and address of Sewage Contractor: �p�,r �t-,�.! a " 74‘1, � 1?
i
THE UNDERSIGNED hereby applies for a permit to construct a new (.') and or alter
a sewage system on above property. The construction and specifications are to be
in accordance with the "Minimum Requirements and Standards Regulating S: :tarp
t- ' Sewage Disposal in Thurston-Mason Counties."
Applicant's Signatur ddress.�o1 D W- 2 !.�i'� i /
ii NOTE: Please refer to "hinimum Requiremen s and Standards Regulating tary
Sewage Disposal" and the accompanying drawings. • t
1 --
(N t to be Tilled in by applicant) 1
Permit NoAliNg Fee $7.5O ate Issued3.30'(0'1By \ 0 '„h...
Area Sanitarian .
Dates Inspecjed j i yo7- co M p /i -1 - Remarks
Nk. ,-Ns1-n(I we,{ —
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Date Approved Approved By
• (Sanitarian)
(DER) 4
t d From Mason County DV, t
. 61 1 �j'c i-r G*. v jet-a fry 7
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SKLFCH AND DESIGNATE THE FOLLOWING: •
1. property lines and names of streets.
2. Locate all buildings, driveways, septic tank and/or other, drainfie d, . --
,
distribution box and trees.
31 Dimensions of septic tank and drainfieldl
11. Location�of and distance to any stream, lake, Puget Sound, or other
bodi'es of%cwater-within 100 feet of sew ge� system; . ,
5. Location and type-.of -wells On other,water.:supplies within 100 feet ,
of sewage system.- - • .. -. N
.0 I ' • .- .
.. 1.
APPROVED - - ..
AUG 3-.0 2023
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MASON COUNTY�NVIRONhIENFAL HEALTf
DJA -- ,
•
APPROVED
AUG 3 C 2023
M
MASON COUNTY ENVIRONMENTAL HEALTH
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