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HomeMy WebLinkAboutSWG2023-00353 TANK ONLY - SWG Application / Design - 8/22/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 BELFAIR:360 275 4467,EXT 400 . rill 0 Public Health & Human Services ELMA:360-482-5269,EXT 400 " :;'4 FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2023-00353 APPLICANT FRISBY J'ANNA Phone: Address: P 0 BOX 833 BELFAIR, WA 98528 OWNER FRISBY J'ANNA Phone: Address: P 0 BOX 833 BELFAIR, WA 98528 SEPTIC INSTALLER TOM WEAVER-Allied Design Inc Phone: 360-620-7054 Address: 3912 STEELHEAD DRIVE NW BREMERTON, WA 98312 Site Address: 780 E ECKERT RD Primary Parcel Number: 121092200012 Permit Description: Replace septic tank i Permit Submitted Date: 08/22/2023 Permit Issued Date: 09/25/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 09/25/2024 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Septic Tank Only Surfacing Sewage? No Existing Failure? Yes Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 3 Drinking Water Source: Private Well/Spring Additional Details: Hagerman 1250 ST 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. 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. 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. ik" OFFICIAL USE ONLY MASON CO NT UG z 41413 ' DATE RECEIVED: 1 Cn D COMMUNI S c AA111 RECEIV W Cn m Public Health(Community Health/EnvironmentalHealth) 1j v cn on 415 N.6th S e,et t.She4to0D ix WA 985 4 ext.400 S W G l�C��� "C� t 41 S N.6M Street Shelton.WA 98584 Z ch ON-SITE SEWAGE TANK ONLY APPLICATION 3 73 APPLICANT PHONE ni .S(✓ ./N F-"X'. (S/2r ,30 - t�2 L' 7 0_3- z MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 3 7ig o 2 , C A-- L f J 64,/t PP V/ �l� al SITE ADDRESS-STREET,CITY,ZIP CODE • `�>9nie H NAME OF DESIGNS J PHONE O r �,Z O r_� . m (4lL'�Vr/L IN NAME OF INSTALLER PHONE / L, ZC, — L's�/ I� 7/;t YY/�•/c� v /91 uc,d Sfzil C TYPE OF WORK(select one) DRINKING WATER SOURCE O ❑ NEW CONSTRUCTION/UPGRADES O.REPAIR/REPLACEMENT PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z I T COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM 1 yin SEPTIC TANK 0 PUMP TANK ❑RV HOLDING TANK BEDROOM LOT SIZE �J i El OTHER y 2'' I 1 OTHER DETAILS(select all that apply) L��(=r 7,4 N it TANK(S)SETBACK CHECKLIST r I ❑ SURFACING SEWAGE EXISTING FAILURE 0 SHORELINE 100FT+PUBLIC/COMMUNITY WELLS n SUBMITTALS .� 50FT+PRIVATE WELLS.SURFACE WATERS,STREAMS.RIVERS PLOT PLAN(REQUIRED) ErTANK CROSS SECTION(REQUIRED) a-10FT+DRINKING WATER SUPPLY LINES ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) _.131 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST r b n PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES ❑ WELLS WITHIN 100FT 0 WATER SUPPLY LINES 0 DRIVEWAYS/PARKING ❑ SURFACE WATERS,STREAMS,RIVERS,ETC... ,f(I DIRECTION OF SLOPE!CONTOURS 0 PERIMETER/CURTAIN DRAINS ❑ NORTH ARROW ❑ SCALE BAR/ I DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) 0 �2 eT��� /`. ( �,v 4 �2 7 7 v / Q TH e 't �� fp4z vim✓ L GxC 6.0 /k/ 7 'Ceti 7-W o .5-�o GULL !/ n-c C OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARI\ MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT 0 OTHER: _ �, COMMENTS/CONDITIONS it ‘P.z.ievALe_ Aoh- c_ -Foliv 1 i AUG 023 ;, SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS". TANKS MUST MEET CURR '(TT MINIMUM SI. �•ll - • NTS.EQUI D WITH RISERS AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATIOt® PORT REQUI�11-- INAL APPRO AL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE [[[ APPLICATION PPFMED/1SSUED EY' DATE ..--------- Ct (,2,ciui py\kA4(\fsvii THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 7/9/2019 1111111111111w • .V.E 24.t& 1 dli!up1r I . ii1;3:45Mq a5KA5§; I FiP,PoziRxr XO � I '�� ig z-$1' Pq odAd^i. n p gC G 3 Ay XRAi-T N Z . 64 , � C 1 (y1�-i W OP,°) n nn SeNpr E > 2 ��c , s 3�c , O , aQL ' 0 ��o;a5 3m1Yz C� g$nz y�A ;?iv O �A �� z ic C Qo ml clo P>F F Z u 3� ,DA o �. � R p I N e 3 0R7 g>�zQgomqgn; N' " 'c N gCI oo' yE„rzqi.- 70 c \ _. I ... 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DATE 6123/1 MKDETMS MODELS DRAFTED BY: 1250 S, 122 50 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: NTS HAGERMAN PRE-CAST i . 4,, b$ f 72-14:cl �, Tr n _a li .21 tl 1 a h e = u n u Ir 1 C ,9 Q2 Cr7 .:47), 14 n n e y '66. xi I I n 1C.� 1 e 1 I II ,y' a N N II 1 I tl n G II44A \ e 1 1 ` K -� Z II n II } Z I e \ II 1 i a N = b a N 4 III. I n , i (/1 N n C21 >' Iy �(Si ti e 'i I r e 1. r i �QD v a (,L) •if— �' N �? 1 I I 1 n I e , g = , 1 r 1�_7,.p==__4....a ___- i „ tt, v = .ran 'R II , I r I I O 1 �S 1 I e PA 1 Y „i 1 Iir. =__ -- .�] -- T ,;�' ,qP.=. = ve I r 1. _ .}e I w -- 1 11 e ' I it !1- u I e e I N n N I 4,.-- - N 1 a : f J e n I II 1 I• II 1 I \\ I I I N 1 1/ \ p n tl 1 ;, I 1 \\11N s n tl 1 .._1- ...ri....NII. p I . .}-... .-..; 1 N 4 1 tl 41. * Am 1 1 I 1 U N tl 1 , I e e II tl I 1 Kk=a.. =.v_11 �__'J " - 4---1. ».--- 1 e 1 0 1. O,. R d Y n ire': ` 'r ^7 -g f. pc1 .f ii 4 Ott PA 3 t r. gga=� Rg $ . ?, 4R ' �3 � " 2 =fi . o .I'n G c ,� - p 4 Q i ...5. a .k s L 1 ..a S 15 •( /. C '$F :Q �;R y ep zs Ti-� o o W ,'. $j- 3 I!IN t. • zz ill N N Ye ci E•`Hi, Oe� n l � 5 tVA42zrnIi_- g ! Ei i I t f: i , V 1p : 'ill _ —I _ r I Wa q d — -ps =.a E K ENGINEERING INC. DATE: TANKCONSTRUCT,ON SCHEDULE RE BAR SpNEaE.OR MODELS D 6/23/11 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: CJi NTS HAGERMAN PRE-CAST '. --'1-Z,i of N NN N.NI.NN m n x r� o .Z o i 0 a F,Q .r co rn rn ki To 0 o xi �_ c N COOh cr, z (> Ca o -13 CO O O O Als _N X 171 RI 0rn co C rn nu v rn23 r N '� G o 0 , o A..) \ , 1 1 al R� , r1 , . II ' of 1 '1a ►rt q \ 1 71 IC n : 0 a iN .� L% . " a Ii'-•—4'S? h , • 3 .7.--.104, h \ L p i s Ku, ` � 7 7 - p Z. O r i��`- �\ t A _ 0 2 .D o m B w z CD o m m cn W o c Q a7 2 \ co CD ri) a� a) CD C Fs m CDrn w : i ° a. d x co x a .1.' 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