HomeMy WebLinkAboutSWG2023-00461 TANK ONLY - SWG Application / Design - 10/26/2023 fl�I MASON COUNTY 4,6N6THELTON: SHELTD70, EXT400
G SHELTON:STREET.
ON. EXT WA 400
BELFAIR:360 275-4467.EXT 400
'S Public Health & Human Services ELMA:360-482-5269.EXT 400
s., T FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2023-00461
APPLICANT MCGREW ANTHONY W& KAREN L Phone:
Address: PO BOX 1326 HOODSPORT, WA 98548
OWNER MCGREW ANTHONY W& KAREN L Phone:
Address: PO BOX 1326 HOODSPORT, WA 98548
SEWAGE INSTALLER TJ Goos-TJ's Excavating Phone: 360-490-0217
Address: 150E MARISA PL SHELTON, WA 98584
Site Address: 201 N Glenwood Rd
Primary Parcel Number: 422165000014
Permit Description: Tank Only
Permit Submitted Date: 10/27/2023
Permit Issued Date: 11/14/2023
Issued By: David Anderson
Current Permit Fees Paid: $255.00 (additional fees may be required upon Installation of system).
Permit Expiration Date: 10/27/2026 )based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Pump Tank Only
Surfacing Sewage? No Existing Failure? No
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Public Water System
Additional Details: Hagerman 1000S
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/healthlenvironmental/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
OCT3 0 2023 DATE RECEDED
MASON COU TY 1 O - ti - 12
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MAILING ADDRESS-STREET.CITY STATE ZIP CODE p 3
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SITE ADDRESS-STREET.CITY.ZIP CODE 7- IS.
20 l N G1en� = I p. 0
NAME OF DESIGNER PHONE S rk I
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NAME OF INSTALLER PHONE3 IP0 9Q GZI 7 II
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TYPE OF WORK(select one) DRINKING WATER SOURCE O
❑ NEW CONSTRUCTION/UPGRADES ❑ REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE' TWO-PARTY WELL Z I�
COMPoNErvi(5)TO BE REPLACE W INSTALLED )cr`PUBLIC WATER SYSTEM L( C�l(^'T c
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❑ SEPTIC TANK $PUMP TANK ❑RV HOLDING TANK BEDROOMS fn LOT SIZE❑ OTHER M
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OTHER DETAILS(Rlw[all the,B(Wlyl TAWS)SETBACK CHECKLIST Q
❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE 100FT+PUBLIC/COMMUNITY WELLS n
SUBMITTALS a 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS.RIVERS X ID
❑ PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) E, ICFT+DRINKING WATER SUPPLY LINES ICI
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) a SFT+PROPERTY/EASEMENT LINES.FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST
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PROPERTY LINES AND EASEMENTS .EXISTING/PROPOSED STRUCTURES a-EXISTING/PROPOSED OSS COMPONENTS AND LINES L~
❑ WELLS YNTHIN 100FT RWATER SUPPLY LINES ❑ DRIVEWAYS/PARKING ❑SURFACE WATERS,.A STREAMS,RIVERS,ETC.. I`
❑ DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS � ¢A RIORTH ARROW SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS'.0x locked gate) I r
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OFFICIAL USE ONLY BELO W THIS LINE
UPGRADE FAILURE SOURCE(lot(spaNnn puryvse>)
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT OHOME SALE ['COMPLAINT 0 OTHER'.
COMMENTS/CONDITIONS
WC/CC P,.7Tivn) YRV, fo#lk v/ c pomp logic
SEWAGE TANKS MUST BE LISTED JNDER 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 APPLICABLEI. RECORD BRAVING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICAT ON ROVED/ISSUED BY DATE
10 (? 7776 76 ly j1 !V/I1067).
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7rz015
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DRAFTED BY. 1000 S, 1000 S-T, m
P.O.BOX 3097 BATTLE GROUND,WA 98604 D.R N. 1000 P & 1000 P-T
PHONE: (360) 687-7668 FAX'. (360) 687-7669 SCALE: a
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PHONE. (360) 6877668 FAX (360) 6874669 SCALE. CP
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280-Series Dimensional Data
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