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Home My WebLink AboutSWG2023-00431 - SWG Application / Design - 10/9/2023 (2) 584 MASON COUNTY 415N 6THELTON: $HELT97 .EXT 400 SHELTON:STREET,SHELTON, -9670,EXT 400 • BELFAIR:360-275-4467,EXT 400 7 PPP 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: 11103/2023 Issued By: David Anderson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of$255.00 (additional fees may be i upon of system). Permit Expiration Date: 10/09/2026 (based on date of nspection) Permit Conditions: 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/healthlenvironmental/onsiteloss-inspection-request.php or call: 360-427-9670,extension 400. OFFICIAL USE ONLY MASON COUNTY `I 10 . C2 13 COMMUNITY SERVICES [ — _ `m w Public Health c m H n E nmenlal Health; o m m -IN < N 1 SWG $ _023 -GuLa_I I0. A ON-SITE SEWAGE TANK ONLY APPLICATION a 'n xi APPLICANT 3 C JOSE BORRAYO 1360-536-6827 m m MAILING ADDRESS•.STREET CI 1v STARE ZIP CODE C /�� 3 9_0 ca SITE ADDRESS.STREET CITY ZIP CODE - I ) 941 N POTLATCH RD, HOODSORT, WA. 98548 I. 0 NAME OF DESIGNER - -- —-1 CINDY WAITE _ ' 360-701-0205 �N NAME OF INSTALLER — PRONE — a / L ./) < TYRE OF WORK(seIeol onn) T DAN ,,p GIP -- W_ r ❑ NEW CONSTRUCTION/UPGRADES ❑ REPAIR I REPLACEMENT I 0 PRIVATE INDI'/II AL NEI I 0 PRIVATE IWG.PARTY WELI O 2 v y w rveNrs)loeE EVLAc_ srqurc 0 PD91 Is wm ERSYSTEM I AKE CUSFIMAN WS - ❑ SEPTIC TANK ❑PUMP TANK IN RV HOLDING TANK 1 BF DRAup I OT IFF 0 OTHER- ) OTHER DETAILS(SPIER/el/1par - —. I L� Pxf TANK GIs — r CI SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINEO ❑ (OFT PUBLIC DMMUNITY WELLS O SUBMITTALS 1 ❑ N/EEL PR VATS II I S.SURFACE WA ERx S-REAMS RIVERS Fs•PLOT PLAN(REQUIRED) TANK CROSS SECTION(REQUIRED) I 0 IOFI-DRINKING Y/ATER SUPPI V LINES ❑ PUMP DETAILS(IF APPLICABLE) IWAIVER(S)(IF APPLICABLE) J 0 5-•PROPERTY.FASLMEN TLINES FOUNDATIONS FOODNGS PLOT PLAN CHECKLIST X S /l. �14�(PPRR�OPERTY LINES AND EASEMENTSp Y•EXISTING/PROPOSED STRUCTURES FETUS-PIG PROPOSED OSS COMPONENT 5 ANS'ONES 0 �p��p!� it ELLS WEIHIN 100FT Y"WATER SUPPLY LINES S.DRIVEWAYS,PARKING refSI/REALF WATFRE STREAMS RIVE RE.E EC, y„ DIRECTION OF SLOPE/CONTOURS WkiERIMETERI CURTAIN DRAINS cir NORTH ARR: 91 SCALE BAR DIRECTIONS TO SITE ANDSITEPOTIONS ma 6 — — 6 7� I-L.afpea tq€ > is t 0AA, La, C�f e.,, AiC 4K..J 6TL —0. c,,.f Tl9* I cPc Aac.L/ IT0i CJ )C: (- /)EIS be r:/1. c,. P.1(44 ORwr 4, .... 4..,, L c... E ,r , E. -- - - - OFFICIALUSEONLYBELUW I I II,[N., T UPGRADE/1ALLRE SOURCE NOT AFFnno e,. ) ❑VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ❑COMP ,TNT ❑OTHER I COMMENTS CONDITIONS - —— --- — — . �2f /t o(• ' tank SENACF TANKS MUST BE LISTED UNDER UCH- S1 OF REGISTERED DEGAGE TANKS A la I ,,Fr T...I. hAMI' AZ;A Er EUS Fu:IPC AND LIDS TO SURFACE AND INCL UDE AN EFFL EN F TER Or APR I' BICI REIXTYO UR S Al pA BEPDX IT IRE'FOP F. SOv 'IEP a INFPECioRSf=NAN DATE C LI'AON EXPIRATION DATE A AlI APpRO\LDI FDB" 1 f SLR/.7g1 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE .._.BED ilTrR2C'I] RV HOLDING TANK SITE PLAN: -PROPERTY LINES&EASEMENTS LEI EXISTING&PROPOSED STRUCTURES a DRIVEWAYS&ACCESS ROADS of EXISTING WATERLINES IS EXISTING&PROPOSED WELLS DPROPOSED HOLDING TANK LOCATION .M SURFACE WATER SOURCES(LAKES, SALT WATER) Di APPROXIMATE RV LOCACTION ❑ CRITICAL AREAS(STEEP SLOPES,CREEKS,WETLANDS) [NORTH ARROW&SCALE BAR APPROVzr NOV 032023 h 1 �Ll' II_ DMA REFERENCED SETBACKS PER WAC246-272A-021o: TANK TO SURFACE WATER AND/OR PRIVATE WELL-SOFT TANK TO BUILDING FOUNDATION.SFT TANK TO COMMUNITY WELL- 100FT TANK TO PROPERTY OR EASEMENT LINE-SET TANK TO CRITICAL AREA-CONTACT PLANNING DEPT. 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