HomeMy WebLinkAboutSWG2024-00065 - SWG Application / Design - 2/23/2024 rli % A
MASON COUNTY 415 N 6TH STREET,SHELTON,967 , 98400
SHELTON:36 42 EXT, 400
584
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: SWG2024-00065
APPLICANT VOTE MICHELLE Phone:
Address: 8514 18TH AVE NW SEATTLE, WA 98117
OWNER VOTE MICHELLE Phone:
Address: 8514 18TH AVE NW SEATTLE, WA 98117
SEPTIC DESIGNER Cindy Waite* Phone: 360-701-0205
Address: 80 E Pickering Lane SHELTON, WA 98584
1
Site Address: 5185 E PICKERING RD
Primary Parcel Number: 220095000026
Permit Description: Replace tanks
Permit Submitted Date: 02/23/2024
Permit Issued Date: 02/28/2024
Issued By: Rhonda Thompson
Current Permit Fees Paid: $265.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 02/28/2025 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic and Pump Tanks
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Private Well/Spring
Additional Details: Septic and pump tank
Permit Conditions:
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.
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 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/healthlenvironmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
t , MASON COUNTY DATE RECEIVED: /1 7
COMMUNITY SERVICES W
AMOUNT RECEIVED: �� RECEIVED BY:
CA v N
Public Health(Community Health/Environmental Health) .(7
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360-427-9670,ext.400 a 360-275-4467,ext.400 /'' �'�
415 N.6th Street-Shelton,WA 98584 S W G - 2 z/ Je4 i^ Z xi
ON-SITE SEWAGE TANK ONLY APPLICATION 3
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73
APPLICANT PHONE II-
MICHELLE VOTE 206-930-9466 z
MAILING ADDRESS-STREET.CITY STATE.ZIP CODE �1, '�\,; '✓ �\\ g
8514 18TH AVE NW, SEATTLE, WA. 98117 \�\v M
SITE ADDRESS-STREET.CITY.ZIP CODE \Cy '�J ,�rl �
�y N
5185 E PICKERING RD � ..1
NAME OF DESIGNER
NE
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CINDY WAITS 3620-701-0205
NAME OF INSTALLER WI/ PHONE C)
TBD Z
TYPE OF WORK(select one/ DRINKING WATER SOURCE O
❑ NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT El PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z
COMPONENT(S)TO BE REPLACED!INSTALLED El PUBLIC WATER SYSTEM 1
II SEPTIC TANK ® PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE I Ul
❑ OTHER 2 90'x425' 03
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r I O
1
o SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE 0 100FT+PUBLIC/COMMUNITY WELLS 'X I O
SUBMITTALS El 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
I] PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) 0 10FT+DRINKING WATER SUPPLY LINES I O
Q PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 0 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST O I O
O PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES II EXISTING/PROPOSED OSS COMPONENTS AND LINES
gia WELLS WITHIN 100FT M WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS.RIVERS,ETC.. I N
O DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS III NORTH ARROW IN SCALE BAR
Cm
DIRECTIONS TO SITE AND SITE CONDITIONS(ex locked gate)
GO NORTH ON HIGHWAY 3, TURN RIGHT ONTO PICKERING ROAD, FOLLOW TO
ADDRESS ON THE LEFT SIDE OF PICKERING. STAY TO THE RIGHT AND FOLLOW TO
PARCEL
REFER TO ATTACHED LETTER PAGE 5
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER:
COMMENTS/CONDITIONS
VQ,0J1(,(0-- 4rik r'(- \'1%
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
2.in
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
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SECURED LID WITH GAS TIGHT SEAL
i 24"DIAMETER
ACCESS RISER O CEg `Z 3 2�24
1t 1 FINISH GRADE
1 By f—
�L TO PUMP
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CHAMBER
FROM SEWAGE
SOURCE FLOATING MAT
APPROVED
EFFLUENT
FILTER
SEDIMENTS
PPROVED
sEPTIC TANK FEB 2 8 2024
(Timm..) MASON COUNTYE4WRONMEh'TAL hEAL1
SECURED))ID WITH GAS TIGHT SEAL PET
THREADED UNION
FINISH GRADE 1- 24"DIAMETER
ACCESS RISER SERVICE
FINISH GRADE - -/ Ni
VALVE*
FROM SEPTIC __[I, A l 1' I'>>
TANK �� ii
�� ,�� TO DRAINFIELD
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EMERGENCY STORAGE ANTI SIPHON
11 VALVE*
HIGH WATER ALARM LEVEL
WORKING VOLUME1 INDEPENDENT
FLOAT NORMAL TIMER OFF LEVEL - FOR FLOAT
ENCLOSED PUMP MOUNTING
SEDIMENT SHROUD* lap - CHECK VALVE'
— 18" 11
SEDIMENTS 1 _ SUBMERSIBLE
CENTRIFUGAL
PUMP
PUMPCHAMBER
(nPIcA) i r" 61.4
p *AS NEEDED 3`
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Cindy Waite
80 E Pickering Lane
Shelton, Wa. 98584
360-426-2113
360-701-0205
cindyewaite@msn.com
2/21/2024
RE: 5185 E Pickering Rd
Parcels #22009-50-00026
At time of septic and pump tank installation. timed dosing will be required. Will need to
confirm that pump has a squirt height of at least 2'. System was sized at 300 GPD,
operating capacity should be 225 GPD
Respectfully submitted
Cindy Waite
APPROVED
FEB 2 8 2024
MASON COUNTY ENVIRONMENTAL HEALTH
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