HomeMy WebLinkAboutSWG2023-00436 - SWG Application / Design - 10/11/2023 MASON COUNTY 415 Nfi HSTREE ,SHELTON, 584
SHELTON: 967 ,EXT40
BELFAIR:360-275-4467,EXT 400
r Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2023-00436
OWNER MSE20 LLC Phone: 425-615-1639
Address: PO BOX 12048 OLYMPIA, WA 98508
APPLICANT MSE20 LLC Phone: 425-615-1639
Address: PO BOX 12048 OLYMPIA, WA 98508
SEPTIC INSTALLER BILL MCTURNAL Phone: 360-866-4594
Address: PO BOX 12048 OLYMPIA, WA 98508
Site Address: 120 E LAKESHORE DR WEST
Primary Parcel Number: 220185000147
Permit Description: Replace septic tank
Permit Submitted Date: 10/11/2023
Permit Issued Date: 12/04/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: 5255.00 (additional lees may be required upon installation of system).
Permit Expiration Date: 10/11/2026 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic 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: Norwesco 1250g ST
Permit Conditions:
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
4 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
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.
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.govlhealth/enviranmentallonsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
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ON-SITE SEWAGE TANK ONLY APPLICATION
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SITE ADDRESS-STREET.CITY ZIP CODE
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NAME OF DESIGNER PHONE.. G
NAME OF INSTALLER PHONE 0 IQ
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DRINKING WATER SOURCE N
TYPE OF WORK(eelecl c!one)
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❑ NEW CONSTRUCTION/UPGRADES REPAIR I REPLACEMENT ❑ PR E INDIVIDUALWELL 0 PRIVATE TWO-PARTY WELL Z
COMPONEN ITO BE REPLACED INSTALLED UBLIL WATER EYST A- 1 I
EPTIC TANK ❑PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE I n
❑ OTHER ele (/� (� t I.
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OTHER DETAILS(exletl aP that apgV)
TANGS) ECK CHECKLIST Q
❑ SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE FT+PUBLIC/COMMUNITY WELLS O
SUBMITTALS 5��p fT+PRIVATE WELLS,SURFACE WATERS.STREAMS.RIVERS
FFFTTT������IIIFT+DRINKING WATER SUPPLY LINES IQ
°BLOT PLAN(REQUIRED) ❑TANK CROSS SECTION(REOUIBLE) PROPERTY/EASEMENT LINES.FOUNDATIONS,FOOTINGS (,
❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) V
PLOT PLAN CHECKLIST
❑ PROPERTRTY LINES AND EASEMENTS 0 EXISTING!PROPOSED STRUCTURES ❑EXISTING/PROPOSED OSS COMPONENTS AND LINES ~ rO I —
❑ WELLS WTHIN 100FT 0 WATER SUPPLY LINES ❑ DRIVEWAYS/PARKING °SURFACE WATERS.STREAMS.RIVERS,ETC.. I f1
❑ DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR I s'
DIRECTIONS TO SITE AND SITE CONDITIONS ( locked gate)•
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OFFICIAL 115E ONLY BELOW THIS LINE
UPGRADE/FA LURE SOURCE(for lepowng purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT °HOME SALE OCOMPLAINT 0 OTHER: .
COMMENTS I CONDITIONS 1�
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SEWAGE TANKS MUST SE LISTED UNDER DOH LIST OF REGISTERED SEWAGE TANKS" TANKS MUST MEET CURRENT MINIMUM SIZE rtbWIREMENT$.EQUIPPED WITH RISERS
AND LIDS TO SURFACE.AND INCLUDE AN EFFLUENT FILTER IIF APPLICABLE/. RECORD DRAWNGAND INSTALLATIONREPORT REQUIRED FOR FINAL APPROVAL _ .
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED EY DATE
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTYWEBSITE T REVISED 14Orz015
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