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HomeMy WebLinkAboutSWG2023-00525 - SWG Application / Design - 12/15/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 a!oil, `V � `�� P' Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2023-00525 APPLICANT STYRLUND REVOCABLE TRUST Phone: VALDEZ J Address: 3231 43rd AVE W SEATTLE, WA 98199 OWNER STYRLUND REVOCABLE TRUST Phone: VALDEZ J Address: 3231 43rd AVE W SEATTLE, WA 98199 Jake SEPTIC INSTALLER LLC Pettit -Vac Tec Septic &Water Phone: 253-268-0322 Address: PO Box 73583 PUYALLUP, WA 98373 Site Address: 19851 NE NORTH SHORE RD Primary Parcel Number: 322185000011 Permit Description: Replace pump basin Permit Submitted Date: 12/15/2023 Permit Issued Date: 12/18/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 12/18/2024 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Pump Tank Only Surfacing Sewage? No Existing Failure? Yes Shoreline? Yes Horizontal Setbacks Met? No Number of Bedrooms: 1 Drinking Water Source: Private Well/Spring Additional Details: Pump basin Permit Conditions: 4 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 2 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County 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: l 1 tm°°'�°`" ��.' MASON COUNTY 2 S 1 �7�� � �. 160o- .1 COMMUNITY SERVICES AMOUNT RECEE J RECEIVED BY: ^ C U) •"f;r •'•"L M` .,.. bl2,9H67: .t.+o czrtno-x y He e�nhf00 vironmental Health) ` i 1J/��[) <CI M cn Al N.6M Street-Shelton,WA 98584 SWG , �/_� - CO 0.. oCT) x SWG Z ui 11 ON-SITE SEWAGE TANK ONLY APPLICATION 3 APPLICANT PHONE m m STYRLUND REVOCABLE TRUST,VALDEZ JVALDEZ J STYRLUND TRUSTEE (206) 459-1460 c MAILING ADDRESS-STREET.CITY,STATE.ZIP CODE g 3231 43RD AVE W SEATTLE WA 98199 °n xi SITE ADDRESS-STREET,CITY,ZIP CODE 19851 NE North Shore Rd, Tahuya, WA 98588 If NAME OF DESIGNER PHONE N In 3 ik.)IfAlkit-Serltrti" ______ NAME OF INSTALLER PHONE 0 I5)j Jake Pettit (253) 268-0322 < — TYPE OF WORK(soled ono) DRINKING WATER SOURCE y ❑ NEW CONSTRUCTION/UPGRADES ® REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL 2 Ith COMPONENT(S)TO BE REPLACED!INSTALLED ❑ PUBLIC WATER SYSTEM r ❑ SEPTIC TANK III PUMP TANK 0 RV HOLDING TANK BEDROOMS • LOT SIZEIT ❑ OTHER ./ , 0.35 acres 0 OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r 0 ❑ SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINE ® 100FT+PUBLIC/COMMUNITY WELLS 0 rr SUBMITTALS El50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS 'v I1 PLOT PLAN(REQUIRED) ® TANK CROSS SECTION(REQUIRED) 111 10FT+DRINKING WATER SUPPLY LINES ❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) II 5FT+PROPERTY!EASEMENT LINES,FOUNDATIONS,FOOTINGS IA PLOT PLAN CHECKLIST - r IM1IIJJ 1r 0 0PROPERTY LINES AND EASEMENTS ® EXISTING!PROPOSED STRUCTURES II EXISTING/PROPOSED OSS COMPONENTS AND LINES --1 IE WELLS WITHIN 100FT MIWATER SUPPLY LINES IL DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... I"-- © DIRECTION OF SLOPE/CONTOURS IL PERIMETER/CURTAIN DRAINS IIIII NORTH ARROW IN SCALE BAR DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) From Belfair Turn left to stay on WA-300 W for 3.3 miles. Continue onto NE North Shore Rd for 16.1 miles. The Destination will be on the left. Follow the driveway down the hill it will be the last house. OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER: COMMENTS/CONDITIONS v—tiecue_e_. PA'''`'‘P bAS(\n , c)N e FT-A-A;r-i-ki SEWAGE TANKS MUST BE LISTED UNDER DOH'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 i z (("Do I--1J-1: e_' -rcirktos -oi P-it b11.3 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 vi liip 2 0O N I CO Ln W c)IE i- o I- I Z i ij } .- O co o ID 3 CO c J .----. C c O O CON .a., C ti OO .0 'O O m r a CO E Now a o c E ICal Z o o . O Q y !CO'./ N N C co 0 y = On Na ¢e C0) co m N C O N -0 O U� p U c3 o D. k c p c: LL )2 o2 tr., W6LL UW _a a ^ E^' ' a. 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