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SWG2023-00321 TANK ONLY - SWG Application / Design - 8/4/2023
MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 I •J 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: SWG2023-00321 APPLICANT WOOLLISCROFT DON & DANA Phone: Address: 2971 E PHILLIPS LK LP RD SHELTON, WA 98584 OWNER WOOLLISCROFT DON & DANA Phone: Address: 2971 E PHILLIPS LK LP RD SHELTON, WA 98584 SEPTIC DESIGNER TOBY SYRETT-septic designer for B Phone: 360-426-4221 line Address: 223 SE Cermak Ln SHELTON, WA 98584 Site Address: E Phillips Lake Loop Rd Primary Parcel Number: 220055100060 Permit Description: New SFR -Septic and Pump Tank Permit Submitted Date: 08/04/2023 Permit Issued Date: 08/28/2023 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) Type of Work OSS New Construction Components being Replaced: Septic and Pump Tanks Surfacing Sewage? No Existing Failure? No Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 4 Drinking Water Source: Private Well/Spring Additional Details: Permit Conditions: 4 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 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. 1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval 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 DATE RECEIVED; c / � ��� C N MASON COUNTY `�.�{ (/ c D COMMUNITY SERVICES AMOUN ECENED: I RFCF!VfD B": jA (n v m cn 0 Public Health(Community Health/Environmental Health) �� — R fn 360-427-9670,ert.400 or 360-275 4467,ert.400 ('` /t /^ /� 415 N.6th Street-Shi4lon,WA 98584 S V\/V a,r.,3 C� U 3.21 Z xp ON-SITE SEWAGE TANK ONLY APPLICATION m n APPLICANT PHONE m r B-LINE CONSTRUCTION 360-426-4221 z MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 2971 E PHILLIPS LAKE RD, SHELTON, WA. 98584 -� CO ! - ,._ 'v II, f! U L.. I xi SITF ADDRESS-STREET,CITY,ZIP CODE U�I y I XXX E PHILLIPS LAKE LOOP RD �' Ai II, IJ A 99' 3 1 ;, _ ( K1 NAME OF DESIGNER PHONE , I IQ TOBY SYRETT 360-426-422 i NAME OF INSTALLER PHONE "" IC v B-LINE CONSTRUCTION 3602-426-4221 < •cn 4 TYPE OF WORK(select one) DRINKING WATER SOURCEo O NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT u❑ PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z I(r1 COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM 1 Igi SEPTIC TANK ® PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE M ❑ OTHER 4 .7 ACRE co OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST 0 r CISURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE III 100FT+PUBLIC/COMMUNITY WELLS n 1 SUBMITTALS ® 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS XIc ® PLOT PLAN(REQUIRED) 8 TANK CROSS SECTION(REQUIRED) I@ 10FT+DRINKING WATER SUPPLY LINES ® PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) ® 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST O I� Igi PROPERTY LINES AND EASEMENTS ® EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES 17 WELLS WITHIN 100FT 8 WATER SUPPLY LINES ® DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... I', © DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS III NORTH ARROW IN SCALE BAR DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gale) PICKERING RD TO PHILLIPS LAKE RD TO PHILLIPS LAKE LOOP. SITE IS ACROSS FROM 1340 BEHIND EXISTING MOBILE HOME. SWG2016-00128 DRAINFIELD WAS INSTALLED FIVE YEARS AGO, SEPTIC AND PUMP TANKS WERE NOT. THIS IS AN UNDEVELOPED PARCEL. WILL SUBMIT A COMPLETE RECORD DRAWING WHEN TANKS ARE INSTALLED. OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) fi 0 ❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ❑COMP 0 OTHER: V E COMMENTS/CONDITIONS AUG 2 8 2023 (Z 00 L, •-,,r MASON COUNTY ENVIRONMENTAL HEAL- /ot�<, JBw 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 L ATION APPROVED.'ISSUED BY DATE $ -2 -zQ • U iesi 5);-2,c-2,5 r THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 RESERVE AREA SOIL LOGS: 0-30"GSL OVER'TILL SATURATED AT 24" 20'ACCESS EASEMENT PRIMARY AREA DRIVE . . . A . . .... .. 1 . .... .... . . . . . . .. . .... _ _ _ — _ .... . . . , . . . ... _ , , . . . / _ . ., , . ...A . . .. . sly.r... s. . . . . . . . . -. 11\11 . . . .3 100'R \\ �"r1: OQ4.„ �v PARKING + ?".:'�';:':,':'-.•S'.o - EXISTING WELL —\," _ _ .11;.:.:_t 7 - 1 ::;*- �u:a:J - it PROPOSED WELL r r / / APP'ROVE "AUG 2 8 2023 M930N COUNTY ENVIRONMENTAL NEALT. Rif' tile . - - - ` ;471 . , � 41 SITE PLAN: 1. " , al, :iimyRpii `"Cii- 11._.. FOR: WOOLLISCROFT JOB#: r o DESIGNER. +, PARCEL#: 22005-51-00060 DATE: 06 MAY 2016 MC PI IRLIC • ' .. .. pIRES: 0 /07/ BY: TJS DESIGN PAGE it, OF t Z MAY 9 2016 NORTH ARROW: ('T� SCALE: 1"= 30' Ew `a' a �. © 1NE CONSTRUCTION, INC. 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