HomeMy WebLinkAboutSWG2023-00384 TANK ONLY - SWG Application / Design - 9/12/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
r Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2023-00384
OWNER HARDIE BRIAN L Phone:
Address: 40 E SQUIRREL TREE CT SHELTON, WA 98584
APPLICANT HARDIE BRIAN L Phone:
Address: 40 E SQUIRREL TREE CT SHELTON, WA 98584
SEPTIC INSTALLER SCOTT JOHNSON-Weather Tight Phone: 360-490-5408
Construction
Address: 8639 Salty DR NW OLYMPIA, WA 98502
Site Address: 40 E SQUIRREL TREE CT
Primary Parcel Number: 321362100150
Permit Description: Replace septic and pump tank
Permit Submitted Date: 09/12/2023
Permit Issued Date: 09/18/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 09/18/2024 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic and Pump Tanks
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 3 Drinking Water Source: Public Water System
Additional Details: Hagerman septic and pump tank
Permit Conditions:
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
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
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/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/environmentallonsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
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OFFICIAL USE ONLY
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ON-SITE SEWAGE TANK ONLY APPLICATION D $
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SITE ADDRESS-STREET.CITY,ZIP CODE
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NAME OF DESIGNER PHONE
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NAME OF INSTALLER PHONE v
wea4-hefright ConS+fc41 04 360 - 763 -15-77
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TYPE OF WORK(select one) DRINKING WATER SOURCE 'ln
❑ NEW CONSTRUCTION/UPGRADES N] REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z Vv
COMP NENT(S)TO BE REP ED/INSTALLED PUBLIC WATER SYSTEM
tri SEPTIC TANK [a PUMP TANK 0 RV HOLDING TANK BEDROOMS , i size_ vt LOT SIZE r
❑ OTHER o•5- 4 c fe I
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OTHER DETAILS(select all that apply) TANK _
)SETBACK CHECKLIST r
ialli❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE 100FT+PUBLIC/COMMUNITY WELLS 0 1
7ISUBMI ALS SOFT+PRIVATE WELLS,SURFACE WATERS.STREAMS,RIVERS
PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) OFT*DRINKING WATER SUPPLY LINES
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) /FT*PROPERTY/EASEMENT LINES,FOUNDATIONS.FOOTINGS I
0
PLOT PLAN CHECKLIST O i,..,_
❑ PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES —1
CIWELLS WITHIN 100FT ElWATER SUPPLY LINES 0 DRIVEWAYS!PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... I
❑ DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS(ex locked gate) I
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OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(tor reporting purposes)
❑VOLUNTARY MAINTENANCE/PUMPING 0 BUILDING PERMIT El HOME SALE ❑COMPLAINT ❑OTHE --
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COMMENTS/CONDIT NS
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V1 \aseffi C, i''r,,L,: SEP 12 2023 U
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SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS' TANKS MUST MEET CURRENT MINIMUM SIIJc.REQTJIREMENTS:EQMiPPE 3-MAIIIRI RS
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
11f` ) lZ`1 9frO123
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE
REVISED 12I7/2015
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EK ENGINEERING INC. DATE: 6/23P11 A. ,',S RUCT Y'$Rt•BAR SCHEDULE cOR MODELS DRAFTED BY: 1250 S, 1250 S—T, m
P O BOX 3097 BATTLE GROUND.WA 98604 D.R.N. 1250 P & 1250 P—T
PHONE: (360) 687-7668 FAX: (360' 687-7669 SCALE: CP
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EK ENGINEERING INC. DATE: 6/23/11 TANK DETAILS FOR MODELS T
DRAFTED BY: 1 250 S, 1250 S-T, T
P.G.BOX 3097 BATTLE GROUND,WA 98604 D R N 1250 P & 1250 P-T
PHONE: (360) 687 7668 FAX: (360) 687-7669 SCALE: 4:1.
NTS HAGERMAN PRE-CAST