HomeMy WebLinkAboutSWG2023-00489 - SWG Application / Design - 11/17/2023 MASON COUNTY 415N 6TH STREET,SHE`rON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR'.360-275-4467,EXT non
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX.360-427-7787
On-Site Sewage System Tank Only Permit: SWG2023-00489
OWNER TRAN ET AL NGUYET Phone:
Address: 200 NE RIVERHILL LN BELFAIR, WA 98528
APPLICANT TRAN ET AL NGUYET Phone:
Address: 200 NE RIVERHILL LN BELFAIR, WA 98528
SEPTIC INSTALLER BRANDON THOMPSON-Bay Shore Phone: 360-866-9200
Construction
Address: 2103 HARRISON AVE NW STE 2774 OLYMPIA, WA 98502
SEPTIC DESIGNER Adam Hunter-Jim Hunter and Phone: 360-753-1226
Associates
Address: PO Box 162 OLYMPIA, WA 98507
Site Address: 561 E LAKESHORE DR WEST
Primary Parcel Number: 220185000252
Permit Description: Replace pump tank
Permit Submitted Date: 11/17/2023
Permit Issued Date: 11/27/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 11/27/2024 (based on elate or inspection)
Type of Work OSS Repair
Components being Replaced: Pump Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 3 Drinking Water Source: Public Water System
Additional Details: 1200 g pump tank
Permit Conditions:
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
4 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
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.
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/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
- OFFICIAL USE ONLY
COUNTY DArRLLLI RECEIVED 1 I / l71 Z ODr y n
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ON-SITE SEWAGE TANK ONLY APPLICATION 3• z
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APPLICANT PHONE m
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BAYSHORE CONSTRUCTION 360-866-9200 z
MAILING ADDRESS-STREET CITY.STATE ZIP CODE 3
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2103 HARRISON AVE STE 2774, OLYMPIA, WA 98502 A
SITE ADDRESS-STREET CITY.ZIP CODE
561 E LAKESHORE DR W, SHELTON,WA 98584 I9--)
NAME OF DESIGNER PHONE ['T
ADAM HUNTER 360-753-1226 �J[J
NAME OF INSTALLER PHONE a r
BAYSHORE CONSTRUCTION 360-866-9200 < I^
TYPE OF WORK/select one) DRINKING WATER SOURCE
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O NEW CONSTRUCTION/UPGRADES Q REPAIR I REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z Fs?
OOMPONENOSI TO BE REPLACED/INSTALLED El PUBLIC WATER SYSTEM iIMBERIAKEB r
O SEPTIC TANK El PUMP TANK Cl RV HOLDING TANK BEDROOMS LOT SIZE Ir p
O OTHER 3 029 CO v1
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OTHER DETAILS(select eu that apTIM TANKISI SETBACK CHECKLIST O
O SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE El 100FN PUBLIC/COMMUNITY WELLS 0 I
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SUBMITTALS El SOFT+PRIVATE WELLS.SURFACE WATERS.STREAMS,RIVERS
O PLOT PLAN(REQUIRED) ®TANK CROSS SECTION(REQUIRED) a lorT+ORINKING WATER SUPPLY LINES {—�
El PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 0 SFT+PROPERTY/EASEMENT LINES.FOUNDATIONS.FOOTINGS �/
PLOT PLAN CHECKLIST o r hp
El PROPERTY LINES AND EASEMENTS El EXISTING/PROPOSED STRUCTURES 111 EXISTING/PROPOSED OSS COMPONENTS AND LINES ~ IF-�`
® WELLS WITHIN 100FT Ill WATER SUPPLY LINES El DRIVEWAYS/PARKING El SURFACE WATERS.STREAMS,RIVERS.ETC... I`s(
O DIRECTION OF SLOPE/CONTOURS El PERIMETER/CURTAIN DRAINS O NORTH ARROW ®SCALE BAR ILX`
DIRECTIONS TO SITE AND SITE CONDITIONS.(ei.rucked Rule)
AGATE RD TO A LEFT ATE TIMBERLAKE D TO A RIGHT ON LAKESHORE DR,
FOLLOW TO SITE ON THE LEFT.
- - - - OFFICIAL USE ONLY BELOW THIS LINE-- - - --
UPGRADE I FAILURE SOURCE Nor repMmg Purposes)
O VOLUNTARY 0 MAINTENANCEIPUMPING °BUILDING PERMIT °HOME SALE °COMPLAINT 0 OTHER.
COMMENTS I CONDITIONS
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SEWAGE TANKS MUST BE LISTED UNDER UGH'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 APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED By DATE
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 13n12015
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