HomeMy WebLinkAboutSWG2023-00431 - SWG Application / Design - 10/9/2023 a : MASON COUNTY 415N 6TH STREET,SHELTON.WA 90584
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 Permit: SWG2023-00431
APPLICANT Jose Barrayo Phone: 360-536-6827
Address: 5690 Beaver Valley Rd CHIMACUM, WA 98325
OWNER Jose Borrayo Phone:
Address: 5690 Beaver valley Rd CHIMACUM, WA 98325
SEPTIC DESIGNER CINDY WAITE-Septic Designer Phone: 3607010205
Address: 80 E PICKERING LANE SHELTON,WA 98584
Site Address: 941 N Potlatch Dr
Primary Parcel Number: 423185100086
Permit Description: RV Holding Tank
Permit Submitted Date: 10/09/2023
Permit Issued Date: 11/03/2023
Issued By: David Anderson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 10/09/2026 (based on dale ofiinspectionl
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.
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 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 __ _--
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ON-SITE SEWAGE TANK',ONLY APPLICATION a• D
APPLICANT - • m
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JOSE BORRAYO
MAIJNG ADDRESS.STREET LIP',STATE ZIP CODE � - 360-536-6827 -j
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941 N POTLATCH RD, HOODSORT;.WA, 98548 L%
NAME OF DESIGNER
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CINDY WAITE 36O-701-0205 11`1
NAME OF INSTALLER
PHONE
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TYPE OF WORK(aelecl one) — <
DRINKING WATER SOURCE O _
❑ NEW CONSTRUCTION I UPGRADES 0 REPAIR REPLACEMENT ❑ PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELT.
COMPONENT(E)TO BE REPLACED,INSTALLED O PUBLIC WATER SYSTEM LAKE CUSHMAN WS
❑ SEPTICTANK ❑PUMP TANK IMI RV HOLDING TANK BEDROOMS /
LOT SIZE � )
❑OTHER
INOTHER DETAILS(Selected)Rat apply) TAWS)SETUACK CHECKI 1ST m
❑ SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE 0 100FH PUBLIC/COMMUNITY WELLS n IC),
SUBMITTALS 0 SCFT.PRIVATE WELLS,SURFACE WATERS,STREAMS RIVERS x I`),
(i PLOT PLAN(REQUIRED) ('TANK CROSS SECTION(REQUIRED) 0 10FTa DRINKING WATER SUPPLY LINES lI!\�
❑ PUMP DETAILS(IE APPLICABLE) ®'WAIVER(S)(IF APPLICABLE) 0 SFA PROPERTY/EASEMENT LINES.FOUNDATIONS,FOOTINGS 1
PLOT PLAN CHECKLIST - — r
ix PROPERTY PPROPERTY LINES AND EASEMENTS 0.EXISTING/PROPOSED STRUCTURES �EXISTING/PROPOSED Oes COMPONENTS AND LINES a �p�y`�g14VEI IS WITHIN 100FT Tit WATER SUPPLY LINES AURIVEW w(
AYSI PARKING $SURFACE WATERS,STREAMS.RIVERS,ETC..14 DIRECTION OF SLOPE/CONTOURS OERIMETER/CURTAIN DRAINS CV NORTH ARROW JQ SCALE BAR /{'�\DIRECTIONS TO SITE AND
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❑VOWNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE ❑COMPLAINT ❑OTHER.
COMMENTS I CONDITIONS
/7U /told', tank
SEWAGE TANKS MUST BE LISTED UNDER DOH-LIST OF REGISTERED SEWAGE TANKS TANKS MUST MEET CURRENI MINIMUM SIZE REQUIREMENTS,EQUIPPED WITH RISERS
AND LIDS TO SURFACE AND INCLUDE AN EFFLUENT FILTER(IFAPPLICABLE). RECORD DRAWING AN]INSTALLEl ION REPORT REQUIRED FOR FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRAODN DATE
APpLICgTI APPROVED}1S5UEp BY DATE
l 0/7(7016_-_
THIS FORM MAY BE SCANNER AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE �..-
REVISED pT/o9,So1B
RV MOLDING TANK SITE PLAN:
,PROPERTY LINES&EASEMENTS Flie
EXISTING&PROPOSED STRUCTURES
A DRIVEWAYS&ACCESS ROADS ljEXISTING WATERLINES
13 EXISTING&PROPOSED WELLS p�pfPROPOSED HOLDING TANK LOCATION
In SURFACE WATER SOURCES (LAKES,SALTWATER) LSY/A PPROXIMATE RV LOCACTION
o CRITICAL AREAS(STEEP SLOPES,CREEKS,WETLANDS) FUNORTH ARROW&SCALE BAR
5?e a / 4 de`f
APPRovE[:
NOV 0 3 2023
MASON COUNTY ENVIRONMENTAL HEALP
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REFERENCED SETBACKS PER WAC246-272A-0210:
TANK TO SURFACE WATER AND/OR PRIVATE WELL-50FT TANK TO BUILDING FOUNDATION-5FT
TANKTO COMMUNITY WELL-100FT TANK TO PROPERTY OR EASEMENT LINE-5FT
TANK TO CRITICAL AREA-CONTACT PLANNING DEPT TANK TO WATERLINES- 10FT
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APPROVED
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NOV 0 3 2023 51
MASON COUNTY ENVIRONMENTAL HEALTH
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APPPDX- WE1G- 1 1 1 ,000 LPS.