HomeMy WebLinkAboutSWG2024-00014 - SWG Application / Design - 1/8/2024 1r4 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
.rrrrr111 SHELTON:360-427-9610,EXT 400
BELFAIR'.360-215-4467,EXT 400
Public Health & Human Services ELMA'360-482-5269.EXT400
FAX'.360-427-7787
On-Site Sewage System Tank Only Permit: SWG2024-00014
OWNER SCHUTT HEATHER I &TRAVIS J Phone: 1.360.623.5375
Address: 90 SE LEGACY LN SHELTON,WA 98584
APPLICANT HOUSE BROS CONSTRUCTION Phone:
Address: PO BOX 1820 MCCLEARY, WA 98557
SEPTIC DESIGNER Adam Hunter-Jim Hunter and Phone: 360-753-1226
Associates
Address: PO Box 162 OLYMPIA, WA 98507
SEPTIC INSTALLER HOUSE BROTHERS Phone: 260-495-4156
Address: PO BOX 1820 MCLEARY,WA 98557
Site Address: SE Legacy Ln
Primary Parcel Number: 319113300020
Permit Description: Lift pump
Permit Submitted Date: 01/08/2024
Permit Issued Date: 01/10/2024
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $265.00 (additional ees may be required upon installation of system).
Permit Expiration Date: 01/08/2027 (based on date of inspection)
Type of Work OSS New Construction
Components being Replaced: Pump Tank Only
Surfacing Sewage? No Existing Failure? No
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 3 Drinking Water Source: Private Well/Spring
Additional Details: lift Pump to gravity tank
Permit Conditions:
3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
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
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.govlhealthlenvironmental/onsiteloss-inspection-request.php or call:
360-427-9670,extension 400.
OFFICIAL USE ONLY
DATE RECEIVEDrifaI '.
MASON COUNTY 1 - 8 - gr)a- to N
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ON-SITE SEWAGE TANK ONLY APPLICATION z
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APPLICANT PHONE r
HOUSE BROTHERS 3604708718 z
MAILING ADDRESS-STREET CITY,STATE,ZIP CODE m
PO BOX 1820, MCCLEARY, WA 98557 m
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SITE ADDRESS-STREET CITY,ZIP CODE --
90 SE LEGACY LN,SHELTON,WA 98584 I V"
NAME OF DESIGNER PHONE I—
ADAM HUNTER 3607531226 r �
NAME OF INSTALLER PHONE a o
HOUSE BROTHERS 3604708718 5 (—
TYPE OF WORK(select RAW DRINKING WATER SOURCE N
O NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT El PRIVATE INDIVIDUAL WELL O PRIVATE TWO-PARTY WELL Z I
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COMPONENT(S)TO BE REPLACED/INSTALLED PUBLIC WATER SYSTEM
O SEPTIC TANK 0 PUMP TANK O RV HOLDING TANK BEDROOMS LOT SIZE ICS
O OTHER 2 COMP.SEPTIC I PUMP TANK(LIFT TO SEPTIC TANK) 3 10.01 W L^, `ry'
OTHER DETAILS(Select all P TANK(S)SETBACK CHECKLIST r I'
arapply)0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE 01UOFT+PUBLIC/COMMUNITY WELLS 0
SUBMITTALS 0 SOFT.PRIVATE WELLS.SURFACE WATERS,STREAMS,RIVERS 6
O PLOT PLAN(REQUIRED) El TANK CROSS SECTION(REQUIRED) 010FT*DRINKING WATER SUPPLY LINES I4
El PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)BF APPLICABLE) El SFT*PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
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PLOT PLAN CHECKLIST O
O PROPERTY LINES AND EASEMENTS El EXISTING PROPOSED STRUCTURES I! EXISTING/PROPOSED OSS COMPONENTS AND LINES
III WELLS WITHIN 100FT O WATER SUPPLY LINES 13 DRIVEWAYS/PARKING El SURFACE WATERS,STREAMS,RIVERS,ETC...
O DIRECTION OF SLOPE/CONTOURS O PERIMETER/CURTAIN DRAINS El NORTH ARROW O SCALE BAR /`q
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex.locked gala) �"
DAHMAN RD TO A LEFT ON LEGACY LN TO SITE TOWARDS END.
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OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(forreoonme purposes) I 1
O VOLUNTARY 0 MAINTENANCE/PUMPING O BUILDING PERMIT OHOME SALE ❑COMPLAINT DOTHER''
COMMENTS/CONDITIONS
SEWAGE TANKS MUST BE LISTED UNDER DON'LIST OF REGISTERED SEWAGE TANKS', TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS.EQUIPPED WR11 RISERS
AND LIDS TO SURFACE.AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL,
SP CT SIGNATURE DATE APPLICATION EXPIRATION DATE - "L �ON AP ROVED;ISSUED BY DATE
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T IS Y BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12Q/2015
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