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Home My WebLink AboutSWG2023-00496 - SWG Application / Design - 11/27/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 JP Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2023-00496 APPLICANT WOODWARD THOMAS J Phone: Address: 5711 208TH ST E SPANAWAY, WA 98387 OWNER WOODWARD THOMAS J Phone: Address: 5711 208TH ST E SPANAWAY, WA 98387 SEPTIC DESIGNER CINDY WAITE-Septic Designer Phone: 3607010205 Address: 80 E PICKERING LANE SHELTON, WA 98584 Site Address: 121 E SHANNON PL Primary Parcel Number: 322125000016 Permit Description: ATF replacement of septic tank Permit Submitted Date: 11/27/2023 Permit Issued Date: 12/05/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 12/05/2024 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Septic Tank Only Surfacing Sewage? Yes Existing Failure? Yes Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 1 Drinking Water Source: Private Well/Spring Additional Details: Septic tank Permit Conditions: 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. 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.gov/health/environmental/onsiteloss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY -- DATE RECEIVED: NO / MASON COUNTY 11 - 1-� - .1' /QD�}� -.07.H. .--.' COMMUNITY SERVICES AMOUrve yEyt_ _ liL,,,„ ,, I Do �O/�cn Public Health(Community Health/Environmental Health) 0l5`� ,6:0 TT�� 360-427.9670,ext.400 or 360.275-4467,ext.400 0 415 N.6th Sheet-Shelton,WA 98584SWG (yaqat, 0 Z 6 ON-SITE SEWAGE TANK ONLY APPLICATION D m xi rn m APPLICANT PHONE r THOMAS WOODWARD 253-380-8213 Z MAILING ADDRESS-STREET.CITY.STATE.ZIP CODE g 0 5711 208TH ST E, SPANAWAY, WA. 98387 m SITE ADDRESS-STREET.CITY.ZIP CODE 1311 N E TAHUYA RD, TAHUYA, WA. 98588 _ W NAME OF DESIGNER PHONE I n) CINDY WAITE 3620-701-0205 NAME OF INSTALLER PHONE 0 ►i - tio(Ai k/ ui TYPE OF WORK(select one) DRINKING WATER SOURCE Welk,' O ❑ NEW CONSTRUCTION/UPGRADES 0 REPAIR!REPLACEMENT g PRIVATE INDIVIDUAL.IIJ 4 .0 PRIVATE TWO-PARTY WELL Z 1 fV COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM t SEPTIC TANK 0 PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE 1 01 O OTHER r 70'X412' CO _ 1— O OTHER DETAILS(select all that apply) TSNK.(S)SETBACK CHECKLIST 0 ❑ SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINE 100FT+PUBLIC/COMMUNITY WELLS Nig/ n 1 IO SUBMITTALS 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS.RIVERS ML ® PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) 10FT+DRINKING WATER SUPPLY LINES0 I CD COPUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) — 5FT+PROPERTY/EASEMENT LINES.FOU DATIONS,FOOTINGS41a PLOT PLAN CHECKLIST r I O CI PROPERTY LINES AND EASEMENTS ® EXISTING!PROPOSED STRUCTURES Ili EXISTING/PROPOSED OSS COMPONENTS AND LINES —I ❑ WELLS WITHIN 100FT ® WATER SUPPLY LINES M DRIVEWAYS!PARKING ®SURFACE WATERS.STREAMS.RIVERS,ETC... 1 —.a 0 DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS III NORTH ARROW ®SCALE BAR I CD DIRECTIONS TO SITE AND SITE CONDITIONS (en .ticked gate) GO NORTH ON HIGHWAY 3, TURN LEFT ONTO OLD BELFAIR HIGHWAY, TURN LEFT ONTO HIGHWAY 300(NORTHSHORE ROAD) TURN RIGHT ONTO BELFAIR TAHUYA RD, TURN LEFT ONTO NE TAHUYA RIVER ROAD, PARCEL IS ON THE LEFT SIDE OF ROAD ON THE RIVER OFFICIAL USE ONLY BELOW THIS LINE UPGRADE I FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE COMPLAINT ❑OTHER' COMMENTS/CONDITIONS /von__ reArtA,' (wart- c �� L U { 00 . sod SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS' TANKS MUST MEET CURRENT MINIMUM SIZE REQUIR NIENTS,EQUIPPED WITH RISERS AND LIDS TO SURFACE.AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWNG AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL I, INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE `z( r2—`1 k—/ ''4 (LIC(Z 3 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 Amu alit Bamford septic Ropa/r,LLC 301 E. Wallace Kneeland Blvd STE#224-332 13607902364 Shelton, WA 98584 PROPERTY INFORMATION Location:1311 NE TAHUYA RIVER RD TAHUYA Tax ID:322125000016 Mall To. Thomas Woodward Use:Residential,Single Family GENERAL SYSTEM TYPE:Conventional(Non-Pressurized) ON ID:322125000016 County Area: Hood Canal Fo'C — ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT Ho, Inspected:11/07/2023 - Inspection Type:ROUTINE - Correction Status:No corrections needed Company: Work Performed By. Submitted 11/08/2023 by: Bamford septic Repair,LLC Thaddeus Bamford Thaddeus Bamford COMMENTS& GENERAL INSPECTION NOTES No Deficiencies Noted No observed problems. GENERAL SITE&SYSTEM CONDITIONS The General Site and System Conditions were: Fully Inspected Components accessible for service: YES All required service performed(if no-specify omitted inspection items in notes): YES Surfacing effluent from any component(including mound seepage): NO Components appear to be watertight-no visual leaks: YES Improper encroachment(sWdures/impervioussurfaces) NO All riser lids securely fastened upon departure: NIA Electrical repairs needed. If YES describe in comments: N/A Inspected components appear to be in good physical condition: YES Root intrusion on any components. If YES describe in comments: NO Settling problems observed. If YES describe in comments: NO --------- -------------- - -- -------- The house/structure was vacant or used infrequently,assessment of the drainfield was not possible. NO ONSITE SEWAGE SYSTEM INSPECTION DETAIL TANK:Septic Tank-2 Compartment This component was: Fully Inspected - Effluent level within operational limits(if NO explain in comments): YES All required baffles in place(N/A=No baffles required): YES Compartment 1 Scum accumulation(Inches,if other specify): Compartment 1 Sludge accumulation(Inches.if other specify). Compartment 2 Scum accumulation(Inches,if other specify): Compartment 2 Sludge accumulation(Inches,if other specify): Pum.in.recommended: NO Distribution:D-Box This component was: Not Inspected D-Box in good condition: D-Box outlets set to allow e.ual effluent distribution: grainfield(disposal):Gravity This component was: Fully Inspected Component appears to be functioning as intended: YES Ponding present?If YES explain in comments: NO Drainfield was vacuumed.flushed or hydro-jetted?(If YES,explain in comments) NO roe report indicates certain characteristics of the onsrte sewage system at the time of visa.in no rosy is tots report a guarantee of operation or future performance. ReportiD:1236543 View inspection reports online at www.onlinerme.com Page 1 of 1 ISII II.It k NOW m •co m a fill • APPROVED C� J E 1�'`+,6 c� 6, N OFC 0 5 2023 MASON COUNTY , /v 00 ..all,." i E4VIr?ONMENTAL HEALTH --rtNk RET N... - c' c• U, O ,eye 4c.r —I . 9' - D e,,‹ 1 h Ifk."- -43,„Is , - l 2I P '/ (� 1i O� CINStO 8 R`4�. �/? of '� or LIC ED D SIGNER % 1(1i 4 �\i►\ �.\� Ii� lk 0•N\ ,1 Exi„RE, 45tO pt•Jpt-, -ra L.),sk- 9v , t 2-0 ' 1 3`'' i - 30 ' /311 NE rah" ?` , `I AFTER THE FACT RECORD DRAWING, pg 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Owner Name THOMAS WOODWARD Assessor Parcel# 3.2z 12► -50-00016 Mailing Address 5711 208TH ST E O/M Specialist Name City, State, Zip SPANAWAY, WA. 983& taller Name Site Address 1311 NE TAHUYA RD Designer Name Please complete this checklist to the best of your knowledge. If items are unknown leave blank. INSTALLATION CHECKLIST System Type GRAVITY Pretreatment Type Drainfield Ln. Ft. 3'X30' Drainfield Sq. Ft. 270 Drainfield depth >5 ft. from foundation? - - ❑ N/A A YES ❑ NO >50 ft. from wells? - - - - ❑ N ❑ Z >50 ft. from surface water? - s 1lk�,- ❑ EN ❑ Q Cleanout between building and tank? - ` ❑ CI U Tank baffles present? - (-EC 13- 1 - - ❑ n ❑ f-- 24" access risers over each compartment?- ❑ ❑ a W Effluent filter installed?- ❑ ❑ Z Septic tank size 1000 gal Manufacturer JNKNOWN 0 D-box water level and speed levelers used? - - ❑ N/A 21 YES ❑ NO �J ❑ CIZI O Manifold/D-box accessible from surface?- - m Z Check valves installed? - - itl ❑ ❑ OQ 2 Transport Line Size Schedule/Class Bedrooms installed (if known) 212 ❑3 ❑4 ❑ 5 El 6 ❑Commercial/Other >10 ft.from foundation? - - -- - - - - ❑ N/A A.YES ❑ NO 0 >100 ft. from wells?- - ❑ [X ❑ W >100 ft. from surface water? - -- - ❑ ❑ Zi c. >10 ft. from potable water lines?- ❑ 21 ❑ Z > 5 ft. from property lines and easements?- - - ❑ Ni ❑ a IA ❑ ❑ � > 30 ft. from downgradient curtain/foundation drains? - - • Observation ports present? - ❑ ❑ EX ❑ Graveless chambers or [g Clean gravel used? (check one)Proper cover installed over drainfield?- - - - - - CI01 ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES [ NO • Pump tank size gal Manufacturer < 24" access riser(s) and accessible from surface?- - - ❑ ❑ ❑ I-- a_ Alarm or Control Panel Installed? - - CI CI 2 Control Panel equipped with Timer/ ETM /Counter- - ❑ ❑ ❑ d Pump installed in ❑ Bucket or ❑ On Block or ❑ Other a'• Pump Make/Model ❑ Floats or ❑ Transducer a • Tank draw down in/min Pump capacity gpm Squirt Height `t Pump on time _ Pump off time Daily flow set at gpd • UpC3:ej 1:::.:.:'4 AFTER THE FACT RECORD DRAWING, pg 2 Assessor Parcel# .1122I2 ..s'U--dda/,L RECORD DRAWING Drainfield&manifold orientation&layout w/dimensions for re-location. 7 Trench/bed dimensions and critical distances within layout 7 Septic/pump tank Location w/dimen- sions for re-location ,Z Location of buildings dexisting/proposedis� {// LLdLes.ervation ports, �'`�Y toe� � 0 �1 i'A," clean-out locations, / &manifolds/d-boxes Td 4 i--c, j71 P ��1� /`eai /0 4, Location of wells, surface water,roads, /� &waterlines. Y fie Ki 17 C 4 tee ej l�Ylw/v ci+iy 21 Reserve area(s) a',,,J ev ki,I,�► Of/ Ribs loci, XNorth Arrow 9 If needed drawing may be attached on a separate page No. Pages Attached CERTIFICATION OF INSTALLATION DESIGNER/APPROVED O/M SPECIALIST I certify that the information contained in this document is accurate to my knowledge. The drawing and information has be obt fined t 1 common locating practices. 2/t/ 2a2 3 Signature of esigner or Approved O/M Specialistr Date MASON COUNTY PUBLIC HEALTH This is an after the fact record drawing, which may or may not include a county inspection. This information is to only document an existing OSS location and components. �zl(512� Signature of Environmental l alttl Specialist Date THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Upd''"''2/2/7a'6 N /r (P14( ��VV RI ,, I r e m O : i { r I t I I fCO' Ida cab,,,, -�hfe q-) A /600 ��il.,, f� —herA,k A t r hCt 0 _ .. t6 F, {:;____..._," 0 ,&x. qi 2 ' x,p .-,i.)• . ,* ri/ .• LID IN'1 AI E ��(,), 1/v\ A�, ar ED D SIGNER t 4 4/'/3(/� ��Ems,,� ',- ‘ %-"-- ► 91 �/Y/"" u, • . ._ . r.,:)%•%Pte., 30' Cu• 9v' r _ 1 t Zo i '' _ So 1 1 1