HomeMy WebLinkAboutSWG2024-00011 - SWG Application / Design - 1/8/2024 ent WA
584
MASON COUNTY 415 N6SHELTON: SHELTON ,EXT 400
SHELTON:STREET.
EXT 400
BELFAIR:360-275-4467,EXT 400
> Public Health & Human Services ELMA:360-482-5269,EXT400
On-Site Sewage System Tank Only Permit: SWG2024-00011
OWNER BROCKETT STEPHANIE J 8 FRANK H Phone: 425-922-7273
Address: 1901 W BEAVER LAKE DR SE SAMMAMISH, WA 98075
APPLICANT BROCKETT STEPHANIE J 8 FRANK H Phone: 425-922-7273
Address: 1901 W BEAVER LAKE OR SE SAMMAMISH, WA 98075
SEPTIC DESIGNER DALE TAHJA-Septic Designer Phone: 360-426-5940
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: 130 SE FERNWOOD LN
Primary Parcel Number: 320224690131
Permit Description: Tank Reselling
Permit Submitted Date: 01/08/2024
Permit Issued Date: 01/10/2024
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $265.00 (additional fees may be.oam.ed upon installation of system).
Permit Expiration Date: 01/08/2027 (based on date of inspection)
Type of Work OS5 Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? Yes Horizontal Setbacks Met? Yes
Number of Bedrooms: 3 Drinking Water Source: Private Well/Spring
Additional Details: Tank resetting
Permit Conditions:
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.
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 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/environmental/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICE AL USE Oi'LC
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MASON COUNTY �1 i co >
COMMUNITY SERVICES m CO
Public Health(Community Health/Environmental Health)
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W MM SWG ���y _ _ s z
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ON-SITE SEWAGE TANK ONLY APPLICATION a a
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APPLICANT PHONE m
Stephanie & Ted Brockett (425) 922-7273 z
MAILING ADDRESS-STREET CRY STATE,ZIP CODE ';
1901 W. Beaver Lake Dr. SE, Sammamish, WA 98075 m
SITE ADwxEss-sIREET cm,ZIP CODE
A
130 SE Femwood Ln., Shelton WA 98584
NAME OF DESIGNER PHONE I� /)
Dale L. Tahja (360)426-5940 Yry/-�/
NAME OF INSTALLER PHONE VP
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Bucky Manke (360)490-0791 Z '�
TYPE OF WORK Galan one/ DRINKING WATER SOURCE M J
❑NEW CONSTRUCTION/UPGRADES ■ REPAIR/REPLACEMENT 0 PRIVATE INDMDUAL WELL 0 PRIVATE TWO-PARTY WELL Z IO/�
COMPONENT(S)TO BE REPLACED/INSTALLED IN
PHBLJG WATER SYSTEM �'/r
•SEPTIC TANK ❑PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SGE lJZ1
❑OTHER re-set existing septic tank 3 1.63 acres m
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OTHER DETAILS(ak4 Mthat appS') TAN(/$)$ERN CH 4 X EpST O
o SURFACING SEWAGE •EXISTING FAILURE N SHORELINE ■ IODFT+PUBLIC/COMMUNITY WELLS C) I
sue/Arras SOFT*PRIVATE WELLS,SURFACE WATERS,STREAMS.RIVERS
•PLOT PLAN(REQUIRED) Ill TANK CROSS SECTION(REQUIRED) • LOFT.DRINKING WATER SUPPLY LINES IC)
❑PUMP DETAILS IF APPLICABLE) ❑ WAIVER(S)OF APPLICARI E) • SET*PROPERTY/EASEMENT LINES.FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST O
• PROPERTY LINES AND EASEMENTS ®EXISTING/PROPOSED STRUCTURES •EXISTING/PROPOSED OSS COMPONENTS AND LINES ' '
• WELLS WITHIN IOOET III WATER SUPPLY LINES ❑DRIVEWAYS/PARKING ❑SURFACE WATERS,STREAMS,RIVERS,ETC..
• DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS ■NORTH ARROW 0 SCALE BAR
DIRECTIONS TO SITE AND SRE CONDITION&(a loCkedgas)
Go out Arcadia Rd., left on CollierRd., right on Old Arcadia Rd., left on Femwood Ln.,
property at end of road, to the right.
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OFFICIAL— - I ONO'SHOW INISLIDNE - ��44N- 5 ' ��7i
i UPGRADE/FAILURE SOURCCE(bapoMo WLpmes) '__� .. a! LC� i �flcpn
E ❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT OHOME SALE DCOMPLAMT DOTHER: �.c 'Kt -
gi COMMENTS I CONDITIONS � - ) V
SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET ry1I2YFNTMNIYUM SIZE REVJWEMENTS,EWIPPE➢NTtN RISERS
li AND LIDS TO SURFACE.MID INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL. I
ELT SIGNATURE DATE APPLICATION EXNPATKKI DATE ;etPPROVED/ISSUED BY DATE i
1 IS (BE 9A AND AVAILABLE FOR PUBLIC VIEW)ON THE�� ®
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