HomeMy WebLinkAboutSWG2023-00509 - SWG Application / Design - 12/4/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
• ' SHELTON:360-427-9670,EXT 400
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BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2023-00509
OWNER LOVELY DANIEL & PATRICIA A Phone:
Address: 6700 SE ARCADIA RD SHELTON, WA 98584
APPLICANT LOVELY DANIEL & PATRICIA A Phone:
Address: 6700 SE ARCADIA RD SHELTON, WA 98584
SEPTIC INSTALLER THAD BAMFORD- Bamford Septic Phone: 360-790-2364
Repair
Address: 301 WALLACE KNEELAND BLVD STE 224-332 SHELTON, WA 98584
Site Address: 6700 SE ARCADIA RD
Primary Parcel Number: 220291290004
Permit Description: Replace pump tank
Permit Submitted Date: 12/04/2023
Permit Issued Date:
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 12/04/2026 (based on date of 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: Private Two-Party Well
Additional Details: Sound Placement
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 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.
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•
OFFICIAL USE ONLY --
MASON COUNTY DATE DECEIVED: I
COMMUNITY SERVICES AMO' Eni PECEIV 8• - W
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' Public Health(Community Health/Environmental Health) Cl)
360-4ne670,«r-400or36o-n5�4467.ext.4130 �/� < (A
415 N.6th Street-Shelton,WA 98584 S\i/G C �� -o o SO O
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ON-SITE SEWAGE TANK ONLY APPLICATION
PLICANT ;� PHONE m m
i 1Q� 1"/fve,,P L.sve-c `3( 6)_358 - g f Z0 c
AILING ADDRESS-STREET.CITY,STATE,ZIP CODE
7-70o Se A az iv
A i dA 4 CO
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SITE ADDRESS-STREET,CITY,ZIP CODE XI
SA-m e IN
NAME OF DESIGNER PHONE IN
OF INSTA R PHONE
.. .Pri c--- -PA-c41 Lc.c ,4o)710 -L36 4
TYPE OF WORK(select ono) DRINKING WATER SOURCE IN
❑ NEW CONSTRUCTION/UPGRADES XEPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL dif PRIVATE TWO-PARTY WELL Z Io
COMPONENT(S)TO BE REPLACED/INSTALLED I 0 PUBLIC WATER SYSTEM
I
❑ SEPTIC TANK XPUMP TANK 0 RV HOLDING TANK BEDR MS LOT SIZE
❑ OTHER 1 ' ( 0 a Cfr-Q,
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1 NI
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST O
n
❑ SURFACING SEWAGE EXISTING FAILURE 0 SHORELINE 0 100FT+PUBLIC/COMMUNITY WELLS 0 I
SUBM TTALS CI50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
KPLOT PLAN(REQUIRED) pLCTANK CROSS SECTION(REQUIRED) ❑ 10FT+DRINKING WATER SUPPLY LINES IO
❑ PUMP DETAILS(IF APPLICABLE) CI WAIVER(S)(IF APPLICABLE) CI 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST I"
)(PROPERTY LINES AND EASEMENTS EXISTING/PROPOSED STRUCTURES EXISTING/PROPOSED OSS COMPONENTS AND LINES
❑ WELLS WITHIN 100FT 0 WATER SUPPLY LINES RIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... I0
❑ DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS XNORTH ARROW P%CALE BAR
1� �r�
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) 1`u � iJ _
p 't ii
Err o 4 2023
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OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:
COMMENTS 1 CONDITIONS
1 ! 000 G -RooA ccip C N° fi ��-
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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 FINALAPPROVAL.
1 INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
\7/I l7 `/t ( (f 1(2 3
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 1217/2015
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APPROVED T
DEC 19 2023
MASON COUNTY ENVIRONMENTAL HEALTH
RET 24' ORENCO TANK ADAPTERS MASTIC
4 CAST-A-SEAL GASKET MI
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4. PVC BAFFLE 4
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FLOOD CAP. 6
FLOOD CAP. 1036 GALS. 504 GALS. 4
55- 1 /2' 52- 1 /2"
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APPROX. WEIGHT 1 1 ,000 LBS.
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