HomeMy WebLinkAboutSWG2023-00229 TANK ONLY - SWG As-Built - 6/8/2023 • MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
a, 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: SWG2023-00229
APPLICANT REED ET AL KIM L & ROBERT W Phone: 253-209-3402
Address: 5115 N 48TH ST TACOMA, WA 98407
OWNER REED ET AL KIM L & ROBERT W Phone: 253-209-3402
Address: 5115 N 48TH ST TACOMA, WA 98407
SEPTIC INSTALLER Shane Maples- MAPLES EXCAVATING Phone: 360-463-8474
Address: 911 SE Arcadia Road SHELTON, WA 98584
Site Address: 50 E SINCLAIR PL
Primary Parcel Number: 220185100112
Permit Description: Add pump basin to connect to existing septic tank
Permit Submitted Date: 06/08/2023
Permit Issued Date: 06/14/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/14/2026 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Other
Surfacing Sewage? No Existing Failure? No
Shoreline? Yes Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Public Water System
Additional Details: Liberty pump basin
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. M
4 Proposed development subject to zoning requirements and ap UNbythe planning
department staff per Mason County Title 17. ,f��,0
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AUG 0 3 2023
MASON COUNTY ENV1R
DJA NMENTAL HEALTH
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 DATE RECEIVED C - e _
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COMMUNITY SERVICES AMOU CE RECEIVED BY C CA
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Public Health(Community Health/Environmental Health) to G5N400 or ert.400
41 N.GM Street-ShettonWA 98584
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ON-SITE SEWAGE TANK ONLY APPLICATION
APPLICANT PHONE m m
Robert Reed 253-209-3402 z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 3
5115 N 48th St. Tacoma, WA 98407 m
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SITE ADDRESS-STREET,CITY,ZIP CODE
50 E Sinclair PI. Shelton, WA 98584 h
NAME OF DESIGNER PHONE I`
NAME OF INSTALLER PHONE v I®
Maples Excavating 360-463-8474 <_
TYPE OF WORK(select one) DRINKING WATER SOURCE
r'NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z
COMPONENT(S)TO BE REPLACED/INSTALLED zr
PUBLIC WATER SYSTEM
❑ SEPTIC TANK .,� PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZEPI
❑ OTHER 0• 35 C _
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r
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CI SURFACING SEWAGE 0 EXISTING FAILURE El SHORELINE JQ 1 OOFT+PUBLIC/COMMUNITY WELLS
SUBMITTALS $ SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
PLOT PLAN(REQUIRED) ❑TANK CROSS SECTION(REQUIRED) . 10FT+DRINKING WATER SUPPLY LINES
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) }' 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST r h'
0
❑ PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES —I
❑ WELLS WITHIN 100FT ❑WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... y I---
❑ DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS'(ex.locked gate)
l i hevt ? 3?2 SoNi S QurrQ - \ iVi Sfi1 k1'Oh tv i f ftk
oc . .tt;'V.1.4 i4' S li C A-oVAk-. , APPROVED
AUG 0 3 20D3
OFFICIAL USE ONLY BELOWTHIS LINE MASON COUNIY ENVIRONMENTAL HEALTH
UPGRADE/FAILURE SOURCE(for reporting purposes) DJA
❑VOLUNTARY ❑MAINTENANCE/PUMPIN BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER: —D r [ L14J1\?H
COMMENTS/CONDITIONS )JUG
A-ath-- �rJ^�S 0,, r�`�/, 6vv I JUN 0 S 2023 i
ici/
SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS". TANKS MUST MEET CURRENT MINIMUM SIZE RE
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 APPLICATION APPROVED/ISSUED BY DATE
(0/11/4-1 (7.60 04\04,\101COK C/14 h/3
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
fisb(i ff- -far (-1 zZ0 9 so 000 73
Ton/c 06 ( 9/3/?oV
Maumaidigia
son County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALT
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APPLICANT/PERMIT INFORMATION
Permit Number sw c c — L o1 U d0
ApplicantParcel# > �p�
Name cti
r �� � Subdivision(Name/Div/Block/Lot) A
APPlicantAddress J /1 /..t MTsv.t I--• 60/ gLi1s SJ13P+v�slun C,uSht"n
City, State,ZiK} {d( purr y y�JG� Ctil�L4U' Installer Name JU
Site Address p -\-,( Designer Name 1111 -i--A Ma
v�.,,cc,, INSTALLATION CHECKLIST
CI PullSystem Installation )ll Tank(s)Only IDOrainrietd Only El Repair 0 Other
System Type ` - Pretreatment Type
>5 ft.from foundation? - - ❑N/A V YES 0 NO
>50 ft.from wells? • - 0 -1:1 0
Y >50 ft.from surface water? - 0 -in
z ❑
111 Cleanout between building and tank? - - El ❑
o Tank baffles present? - - ❑ -0 ❑
fa 24"access risers over each compartment?- • - El -El ❑
W Effluent filter installed?- uu - El CI
tank size (V n(3 gal Manufacturer T7 A6-FefVt-11-I,
0 D-box water level and speed levelers sed? - - ❑N/A ❑YES 0 NO
J
02 Manifold/D-box accessible from surface.- ❑ 0 0
t702 Check valves installed? - - 0 0 0
0<
E Transport Line Size Schedule/Class
Bedrooms installed(check one) 0 2 ❑3 ❑4 ❑5 ❑6 ❑Commercial/Other
>10 ft.from foundation?- 0 N/A 0 YES ❑ NO
Cl >100 ft.from wells?- ❑ ❑ ❑
w >100 ft.from surface water?- 0 0 0
u >10 ft from potable water lines?--- 0 0 0
Z >5 ft. from property lines and easemen ?- ❑ 0 0
12 >30 ft.from downgradient curtain/found ion drains?- • 0 0 0
a
Drainfietd level and observation ports ores nt- • 0 ❑ 0
0 Graveless chambers or 0 Clean gravel used? (check one)
Proper cover installed over drainfield?- - 0 ❑ 0
Pump tank setbacks consistant with septic tank?- - 0 N/A 0 YES ❑ NO
]C Pump tank size al Manufacturer
24"access riser(s)and accessible fro surface?- - 0 ❑ 0
H<
a. Alarm or Control Panel Installed?- El El
2 Control Panel equipped with Timer/ETM! ounter- - 0 ❑ 0
D
O. Pump installed in 0 Bucket or 0 On Block or 0 Other
Pump Make/Model ❑Floats or 0 Transducer
Tank draw down in/min Pump capacity gpm Squirt Height ft
a-
pump on time Pump off time Daily flow set at gpd
•
A. . . ... • .; ,.y F
AUG 0 3 2023
/ MASON COUNTY ENVIRONMENTAL HEALTH
DJA
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/9540111 "CS( LzZ614150000 -3
Mason Carly C S Ims'aiaboe Report pp.2 PastaIIto
ABANDONMENT RECORD
Were exislmg septic components abandoned as part of this project? - 0 YES No
If yes,please describe:
Were all components pumped out and properly abandoned per WAC246 272A-03007 0 YES No
RECORD DRAWING
nth Is a permanent record and must M aceunh and descriptive enough to n-locate In the need of maintenance actrytdes and future development Typical Recall
D mates cotton Dranreld 6 manifold onenlalbn 8 layout,Septic-plmo tank locelan.North arrow,reserve tram(ld.existing and proposed Puddings.Lawton of wells.walertnea,
wets.observation pats.cleancuts,and other manlenance axes,poinls.Inoanplete Record Drawings may create adddanal delays in tnal installation approval and rotated penal.
(.Rococo Drawing Attached
CERTIFICATION OF INSTALLATION TTTTT
INSTALLER DESIGNER/ENGINEER
I certify that!installed the system in accordance with 1 certify that the system has been installed in accor-
Ile.stfdestimstamped aAPPROVIElfI'fmypi/llbuOm tmrlth the septic design stamped'APPROVED'by
COMPItjr PCPW F{kel..tf v e+w0l6vadow devialbans shaar a $10aszin 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.
0 215 )(.) e' 1 3
•ature ofInstaller Date
Ua� 51O
Panted Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health.'
Signature of Environmenta!Health Specialist Date (stamp,signature and date)
THIS FORM MAY NEDANDAVAILABLE FOR PUBLIC VIEW ON THE MASON COON y. .7�' ellA III rt E
Q,92. A�� 032023
MASON COUNTY ENVIRONMENTAL HEALTH
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AUG 032023
MASON COUNTY ENVpJAIRONMENTAL HEALTH