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HomeMy WebLinkAboutSWG2023-00422 - SWG Application / Design - 10/3/2023 MASON COUNTY 015 N 6TH STREET SHELTON,WA 98584 SHELTON: SHELTON, -9670,EXT 400 BELFAIR:360-275-4467,EXT 400 r,l; Public Health & Human Services ELMA. 360-482-5269,EXT 400 FAX:360-427-7767 On-Site Sewage System Tank Only Permit: SWG2023-00422 APPLICANT ALBERTI DAVID CHESTER Phone: Address: P O BOX 2506 POULSBO, WA 98370 OWNER ALBERTI DAVID CHESTER Phone: Address: P 0 BOX 2506 POULSBO, WA 98370 SEPTIC DESIGNER Adam Hunter-Jim Hunter and Phone: 360-753-1226 Associates Address: PO Box 162 OLYMPIA, WA 98507 SEPTIC INSTALLER DARIN OGG-Royal Flush Septic Phone: 360-790-3021 Address: PO BOX 1336 HOODSPORT, WA 98548 Site Address: UNKNOWN Primary Parcel Number: 422165300133 Permit Description:. RV holding tank Permit Submitted Date: 10/03/2023 Permit Issued Date: 10/16/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: 5255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 10/16/2026 (based on date of Inspection) Type of Work OSS New Construction Components being Replaced: RV Holding Tank Surfacing Sewage? No Existing Failure? No Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 0 Drinking Water Source: Public Water System Additional Details: Holding tank Permit Conditions: 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. 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 THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF 055. 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/environmentallonsiteloss-inspection-request.php or call: 360-427-9670, extension 400. --------- OFFICIAL USE ONLY -- --- DATE RFCFIVEP MASON COUNTY I 0 -�-la' v n 0 COMMUNITY SERVICESAMOUNT DU l '� m y Public Health)Community Health/Environmental Health) G y „a.oaTenr mare, eeae. SWG o20 Z'� -007 UZZ o 22 N ON-SITE SEWAGE TANK ONLY APPLICATION 3 A n APPLICANT PHONE m m DAVID ALBERTI 253-948-2969 z MAILING ADDRESS-STREET,CITY.STATE.ZIP CODE 3 PO BOX 2506, POULSBO, WA 98370 A SITE ADDRESS-STREET CITY ZIP CODE 81 N WHITE WAY LN, HOODSPORT,WA 98548 NAME OF DESIGNER PHONE ADAM HUNTER 3607531226 NAME OF INSTALLER PHONE a 9Y ROYAL FLUSH < TYPE OF WORK(select one) DRINKING WATER SOURCE y O NEW CONSTRUCTION I UPGRADES 0 REPAIR I REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL 2 COMPONENT(S)TO BE REPLACED,INSTALLED © PUBLIC WATER SYSTEM LANE CUSHMAN F [ SEPTIC TANK 0 PUMP TANK M RV HOLDING TANK BEDROOMS LOT SIZE ` {� O OTHER 0(RV) 0.22 CO '_ OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST S IUD [ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE 0 100FTe PUBLIC/COMMUNITY WELLS O t SUBMITTALS 0 SOFT•PRIVATE WELLS.SURFACE WATERS,STREAMS,RIVERS 10 ® PLOT PLAN(REQUIRED) ®TANK CROSS SECTION(REQUIRED) El 1OFT+DRINKING WATER SUPPLY LINES [ PUMP DETAILS(IF APPLICABLE) El WAIVER(S)(IF APPLICABLE) 6 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS hI 1 PLOT PLAN CHECKLIST O Q PROPERTY LINES AND EASEMENTS D EXISTING/PROPOSED STRUCTURES ILEXISTING/PROPOSED OSS COMPONENTS AND LINES —I Ir a WELLS WITHIN 100FT E WATER SUPPLY LINES 0 DRIVEWAYS/PARKING [' SURFACE WATERS,STREAMS,RIVERS.ETC... Li El DIRECTION OF SLOPE'CONTOURS O PERIMETER/CURTAIN DRAINS El NORTH ARROW O SCALE BAR ,, DIRECTIONS TO SITE AND SITE OONDI I IONS.(es.locked gate) MI CUSHMAN POTLATCH RD TO A RIGHT ON LOWER LAKE RD TO A LEFT ON KOKANEE RIDGE DR TO A LEFT ON OLYMPIC WAY TO A RIGHT ON WHITE WAY LN TO A LEFT TO SITE ON THE LEFT. ---- - - -- OFFICIAL USE ONLY BELOW THIS LINE - - -- - UPGRADE I FAILURE SOURCE(for reporting purposes) R VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT DHOME SALE[C'CCOMPLAINT�T0 OTHER: • ITIONS COMMENTS an �'IA� 1 cil— 1 01 y�a`— �" -�A1.>" V' I 1,, I U 1 rll SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS.TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS.EOUIEPEO WITH RISERS AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL. INSPECOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE ( bitG / z67 elvircrin 16411..3 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED ml09¢0I9 SCALE-1"=20'-a' APPROVED 94Op2 OCT 16 2023 Gnilr �4ASC!I CC L Ai14CSYE T4L 4EALT.. FSMT RET PROPOSED 1200GAL.HOLDING TANK 14 O pm K \ oy QQ m �a "---PROPOSED STU.OUT/CLEANOUT EXISTING DRIVE PROPOSED 4'TIGHT NE(2%SLOPE REQUIRED) 512.e - 6+ e rF N 8659 s zs12. �N/TF , VLN �..RLFr `t: <TSl>1MIU1AAA44"iP 24 -HIGH WATER ALARM(AUDIO AND VISUAL)REQUIRED JIM HUNTER & ASSOC. -RISERS AND LIDS REQUIRED TO SURFACE P.O. BOX 162, OLY,WA 98507 -WATER-TIGHT FITTINGS 753-1226 -INSTALLATION BY CERTIFIED INSTALLER REQUIRED JHAND ssooATES W HOlmeu COM HOLDING TANK SITE PLAN SITE ADDRESS/LEGAL B1 N WHITE WAY LN OWNER- DAVID ALBERTI LEGAL TP# 42216-53-00133 LAKE CUSHMAN#16 TR 133 Holding Tank Sewage Systems-Recommended Standards and Guidance Effective Date:July 1,2021 Introduction A Holding Tank Sewage System(HISS) is an alternative to a conventional on-site sewage system with very special and limited applications. Simply, the HTSS provides a means to collect and temporarily store sewage from a facility or dwelling,for subsequent removal and transport to an approved treatment and disposal site. Depending upon the facility served or the particular set of circumstances surrounding the use of a HTSS, the expense of sewage pumping, hauling, and disposal at an approved facility can be very costly, especially on a long-term basis. In addition, the potential for operational/management problems with resulting public exposure to raw sewage is significant. For this reason,use of a HTSS must be closely regulated by the local health agency. A HTSS is an on-site sewage system that incorporates a holding tank,the services of a sewage pumper/hauler, and the off-site treatment and disposal of the sewage generated at the site served by the HTSS. Figure 1. Longitudinal-Section of Typical Holding Tank Sewage System. ® Warning Light and Access Riser with secured 1 Audible AlarmPum ping Access Port with gas tight lid \)1 sloped concrete pad —_c�II rte Inlet •4 =I __ from 3 'SIM • structure A P►'ROV Reserve Storage Volume E p I OCT 16 2023 as ccIJ Fvp �acvveti*'ld�lrh Normal Operating Volume RE' *Septic tanks with plugged outlets arc not allowed.Tank must not have an outlet.