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SWG2023-00369 TANK ONLY - SWG Application / Design - 9/1/2023
MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 6": SHELTON:360-427-9670,EXT 400 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: SWG2023-00369 OWNER ALLISON PROPERTY ASSOCIATION Phone: Address: PO BOX 926 PUYALLUP, WA 98371 APPLICANT SARAH MORSE Phone: Address: 840 E MAPLES RD SHELTON, WA 98584 SEPTIC DESIGNER CINDY WAITE- Septic Designer Phone: 3607010205 Address: 80 E PICKERING LANE SHELTON, WA 98584 Site Address: 780 E Maples Rd Primary Parcel Number: 220234190030 Permit Description: Replace septic tank Permit Submitted Date: 09/01/2023 Permit Issued Date: 09/26/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 09/26/2024 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Septic Tank Only Surfacing Sewage? No Existing Failure? Yes Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 2 Drinking Water Source: Private Well/Spring Additional Details: Sound Placement 1200 gallon cement Permit Conditions: 2 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 4 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS. PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS. THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND/OR DESIGN APPROVED. FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES. For Final Inspection visit: masoncountywa.gov/health/environmental/onsiteloss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY "."' MASON COUNTY DATE RECEIVED, ow...,-.'''''.:''''''''', I COMMUNITY SERVICES AMOUNT RECEIVED UI I:TJsr W Ch W ^ < cn �' Public Health(Community Health/Enauonnxvttal Health/ 0 M 160-43]96 I0.er.40eor 360-01544G 1.er1.400 415N RtM1$Irw't•ShN;i,�,14F')vcg4 S Y V G3 -�OLog o� 2 O Z 6 ON-SITE SEWAGE TANK ONLY APPLICATION 3, APPLICANT PH.')NF m ° I— SARAH MORSE 253-606-4963 MAILING ADDRESS-STREET CITY STATE.ZIP CODE C INE MAPLES RD, SHELTON, WA. 98584 m SITE ADDRESS-STREET,CITY,ZIP CODE XJ SAME I Iv NAME OF DESIGNER PHONE CINDY WAITE 360-701-0205 NAME OF INSTALLER PHONE I° TBD R IL TYPE OF WORK(select one) DRINKING WATER SOURCE N ❑ NEW CONSTRUCTION/UPGRADES la REPAIR/REPLACEMENT El PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z I )‘) COMPONENT(S)TO BE REPLACED,INSTALLED 0 PUBLIC WATER SYSTEM ❑ SEPTIC TANK 0 PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE I,' ❑ OTHER 2 3.21 ACRES OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST W I ❑ SURFACING SEWAGE RI EXISTING FAILURE ®SHORELINE • 100FT+PUBLIC/COMMUNITY WELLS 5 (� SUBMITTALS • SOFT+PRIVATE WELLS.SURFACE WATERS.STREAMS,RIVERS I 1 © PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) r 10FT+DRINKING WATER SUPPLY LINES (� ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) SFT+PROPERTY/EASEMENT LINES,FOUNDATIONS.FOOTINGS I ` PLOT PLAN CHECKLIST O IrC` • PROPERTY LINES AND EASEMENTS ® EXISTING/PROPOSED STRUCTURES ®EXISTING/PROPOSED OSS COMPONENTS AND LINES --I S WELLS WITHIN 100FT T WATER SUPPLY LINES El DRIVEWAYS!PARKING •SURFACE WATERS.STREAMS.RIVERS,ETC... I`'N) ® DIRECTION OF SLOPE!CONTOURS ieRIMETER/CURTAIN DRAINS lir NORTH ARROW JR SCALE BAR / 1 �� DIRECTIONS TO SITE AND SITE CONDITIONS:(ex locked gate) GO ACROSS HARSTINE ISLAND BRIDGE, TURN RIGHT AT TEE ONTO SOUTH ISLAND DRIVE, TURN RIGHT AT NEXT TEE ONTO HARSTINE ISLAND ROAD SOUTH, WHEN YOU COME TO 90 DEGREE LEFT, GO STRAIGHT ONTO MAPLES RD, FOLLOW TO ADDRESS ON THE RIGHT SIDE(WATER SIDE) - OFFICIAL USE ONLY I3ELOWTH1>LINE -- - - ------ E.,-_--.....,-__ --+ 07 '' UPGRADE/FAILURE SOU E(for reporting purposes) I• cr) g ❑VOLUNTARY MAINTENANCE/PUMPING ❑BUILDING PERMIT 0 HOME SALE ['COMPLAINT 0 OTHER COMMENTSICONDI ONS O SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS" TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED WITH RISERS lc--s 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 DATF ______-.... et(2,6(el i Rli\RAIV\I°(‘Ylr ' 1*5 T _ - HIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COU NTY WEBSITE .Er;ISFD ,;:',2„;,, r „ . , . .. . 44/-- nu,/ H N s/al0 6,y- i €6 ,1 iz.,SPoyr o , _. A/ue•Pd /i// : ii eblcs-,,. i:Z.:,. t '.• -.-''1",dkp /51u.. N O C D 0, . E UI /. ' LICE DL GNER . 2. O23, // _ qup3O j EXPIRES OS t0 i i SEP 26 2013 � MASON COUNTY '� ENVIRONMENTAL HEALTH 5 `'� i �,P,9',bvt- RET -z ? !�0 0 / 1 ,5"v' 4 wu 1 �sv /(//1/:1..j ‘ CD I 1. - 6-17 e1�1SfIrJ: f; .�� Yl ^,deuG4, r CZ ID-00 et aiqf oh) j _ i / 4.1e1.41 S.4', / ,. • 4%., w ,F1'Ail LNG,{i1 /bo'7Y-- l t.t# / 4 Old Me id --owE Pea/e Pas;6 c 4v • . • n r. f -44/99 6E5 1200NCSR & 1200NCSR—HW (s? 04,,j eea ia ?", . ct..- Ee u 102" 63� 31 " --�—` 2 —� f I I i I 71 " T E (• 18" 24" TOP VIEW 65" 4, or a • L so — �4 L _i___, t ,I i, 1;,,,p 0- ,OfsN '9� co f, SY E AITE dr> ft*1 MA TIC s LiCEYVSEp OE�I c, ::: • T°i ADAPTERS ExniHtS OS, ;6' '4►\:111I' ,...) I-I 4' CAST-A-SEAL GASKET r-- _ - - 4 '�—4. PVC BAFFLE 4 a 4" I _ FLOOD CAP. 965 GALS. FLOOD CAP. 6 5,. 1 463 GALS. 54" J1 " :jO I2- 1 /2` H H APPROVED 3 SEP 2 6 2023 ,,::;CON .:GJN1Y MENTAL HEALTH APPROX. WEIGHT 1 1 ,000 LBS. ENVIRONMENTAL