HomeMy WebLinkAboutSWG2023-00457 - SWG Application / Design - 10/23/2023 MASON COUNTY 415N6THELTON: SHELT96 .EXT 404
SB ELTON:360A2]-96]0.E%T 400
•
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: SWG2023-00457
APPLICANT CRICKMORE KELLY L Phone:
Address: 10431 - 236TH AVE SE ISSAQUAH, WA 98027
OWNER CRICKMORE KELLY L Phone:
Address: 10431 -236TH AVE SE ISSAQUAH, WA 98027
SEPTIC INSTALLER Jake LLC Pettit-Vac Tec Septic&Water Phone: 253-268-0322
Address: PO Box 73583 PUYALLUP, WA 98373
Site Address: 651 SE TOTTEN SHORES DR
Primary Parcel Number: 220315000016
Permit Description: Replace septic tank
Permit Submitted Date: 10/23/2023
Permit Issued Date: 10/25/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon i installation of system).
Permit Expiration Date: 10/25/2024 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 3 Drinking Water Source: Private Well/Spring
Additional Details: Norwesco 1250g ST
Permit Conditions:
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.
4 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
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/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
MASON COUNTY DTBBBEFNFD ID 3 co a
fAI %- COMMUNITY SERVICES L
mc
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5��_ PeenR. MM(Commumh Reelm/En.I,o„m.,,rol Health) � .� ai
11,.6th meet.,,eo. NWAS, ,m SWG 200-3 - ()0-15R Z y
ON-SITE SEWAGE TANK ONLY APPLICATION m n
APPLICANT PHONE r
Kelly E(Giovl Kt. (425) 28111tR `" c
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 11 3
651 Southeast Totten Shores Drive, Shelton, WA 98584 _ - Li z
SITE ADORERS-STREET CITY.ZIP CODE
651 Southeast Totten Shores Drive, Shelton, WA 98584 __ I4i
NAME OF DESIGNER PHONE B 1 ‘-, I,eY 1
Jake Pettit AAA Septic LLC (253) 268-0322
NAME OF INSTALLER PHONE a ID
AAA Septic LLC (Jake Pettit ) (253) 268-0322 R IW
TYPE OF WORK(select one) DRINKING WATER SOURCE y
O
[' NEW CONSTRUCTION/UPGRADES • REPAIR/REPLACEMENT O PRIVATE INDIVIDUAL WELL [ PRIVATE TWO-PARTY WELL Z
COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM
® SEPTIC TANK ❑PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE IT
❑ OTHER 3 Bed 2.55 acres IO
OTHER DETAILS(select all that apply, TANK(S)SETBACK CHECKLIST Q
0 SURFACING SEWAGE m EXISTING FAILURE 0 SHORELINE S 100FT+PUBLIC/COMMUNITY WELLS O ID
SUBMITTALS
• SOFT*PRIVATE WELLS,SURFACE WATERS,STREAMS.RIVERS
❑ PLOT PLAN(REQUIRED) O TANK CROSS SECTION(REQUIRED) S 10FT+DRINKING WATER SUPPLY LINES IO
❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) • 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS.FOOTINGS
PLOT PLAN CHECKLIST O ID
I PROPERTY LINES AND EASEMENTS m EXISTING/PROPOSED STRUCTURES ■ EXISTING/PROPOSED OSS COMPONENTS AND LINES ~
® WELLS WITHIN 100FT • WATER SUPPLY LINES m DRIVEWAYS/PARKING O SURFACE WATERS,STREAMS,RIVERS,ETC... I—
• DIRECTION OF SLOPE/CONTOURS •PERIMETER/CURTAIN DRAINS • NORTH ARROW •SCALE BAR
ioc
DIRECTIONS TO SITE AND SITE CONDITIONS'.(ex.locked gate)
Head north on N 6th St toward W Alder St 108ft, Take E Arcadia Ave and SE Lynch Rd to
SE Totten Shores Dr 10.7 miles, Turn left onto SE Totten Shores Dr go .2 miles, Turn right
to stay on SE Totten Shores Dr .5 miles, Destination is on your left.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for nporTFF purymea)
❑VOLUNTARY O MAINTENANCE/PUMPING ['BUILDING PERMIT [HOME SALE ['COMPLAINT Q OTHER:
COMMENTS/CONDITIONS
pkc,L CI cPrhL 1-Gr1 \C----__
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
kOI'LCh--S UNIll'Al9WI (O (Lcft3
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12,712015
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— -1111 Effluent filter installed in the outlet
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