HomeMy WebLinkAboutSWG2023-00378 TANK ONLY - SWG Application / Design - 9/6/2023 MASON COUNTYit 415 N 6TH STREET, SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
jBELFAIR:360 275-4467,EXT 400?` T Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2023-00378
OWNER LOVELL KEITH A Phone: 360-438-8371
Address: 1027 4th Ave E OLYMPIA, WA 98506
APPLICANT LOVELL KEITH A Phone: 360-438-8371
Address: 1027 4th Ave E OLYMPIA, WA 98506
SEPTIC DESIGNER Adam Hunter-Jim Hunter and
Associates Phone: 360 753 1226
Address: PO Box 162 OLYMPIA, WA 98507
SEPTIC INSTALLER Royal Flush Phone: 3607903021
Address: P.o.box 1336 Hoodsport, WA 98548
Site Address: 61 N Dow Ct
Primary Parcel Number: 423295000129
Permit Description: Holding tank: Recreational/part-time use (RV)
Permit Submitted Date: 09/06/2023
Permit Issued Date: 10/03/2023
Issued By: David Anderson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 09/06/2024 (based on date of inspection)
Type of Work OSS New Construction
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? No
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 3 Drinking Water Source: Public Water System
Additional Details: TBD
Permit Conditions:
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
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/environmental/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
— — OFFICIAL USE ONLY-- - -
'" DATE RECEIVED:
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COMMUNITY SERVICES ^M Rssir „� Public Health(Community Health/Environmental Health)
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41S N.6th Street-Shelton,WA 98584 SV A /G JO ," 97 O
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ON-SITE SEWAGE TANK ONLY APPLICATION n it;
APPLICANT m 2
PHONE m
KEITH LOVELL 3604388371 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE _ --- —— C
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1027 4TH AVE E, OLYMPIA, WA 98506 CD
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N SITE ADDRESS-STREET,CITY.ZIP CODE x
v 61 N DOW CT, HOODSPORT, WA
t\• F
J NAME OF DESIGNER PHONE
ADAM HUNTER 3607531226 I
NAME OF INSTALLER PHONE It ROYAL FLUSH v
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TYPE OF WORK(select one) DRINKING WATER SOURCE
11411
El NEW CONSTRUCTION/UPGRADES ElREPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z
COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM LAKE CUSHMAN
❑ SEPTIC TANK 0 PUMP TANK El RV HOLDING TANK BEDROOMS LOT SIZE I t
❑ OTHER N/A 0.16
OTHER DETAILS(select all that apply) W
TANK(S)SETBACK CHECKLIST r
❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE El 100FT+PUBLIC/COMMUNITY WELLS O
SUBMITTALS 0 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS I
0 PLOT PLAN(REQUIRED) El TANK CROSS SECTION(REQUIRED) 0 10FT+DRINKING WATER SUPPLY LINES
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) El 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST r Ip
PROPERTY LINES AND EASEMENTS El0 EXISTING/PROPOSED STRUCTURES El EXISTING/PROPOSED OSS COMPONENTS AND LINES "1
El WELLS WITHIN 100FT 0 WATER SUPPLY LINES ElDRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... I' 11
I7 DIRECTION OF SLOPE/CONTOURS ❑■ PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) I
LAKE CUSHMAN TO A RIGHT ON DOW MOUNTAIN TO A RIGHT ONROW CT TO SITE
AT END AT CUL-DE-SAC (l ,j cc
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OFFICIAL USE ONLY BELOW THIS �r e/y
UPGRADE/FAILURE SOURCE(for reporting purposes) ��
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT 00TH :
COMMENTS/CONDITIONS
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
APPLICATION APPROVED/ISSUED BY DATE
74/ &1 loll Oz3
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLICr�� �VIEW ON THE MASON COUNTY WEBSITE REVISED 07/09/2019
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