HomeMy WebLinkAboutSWG2024-00083 TANK ONLY - SWG Application / Design - 3/1/2024 p
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MASON COUNTY 415 N 6TH STREET,SHELTON, ,E 985400
84
SHELTON: ,SHEL ON, EXT 584
J 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: SWG2024-00083
APPLICANT PEPPERS JOHN Phone:
Address: 701 EAST LAKESHORE DR E SHELTON, WA 98584
OWNER PEPPERS JOHN Phone:
Address: 701 EAST LAKESHORE DR E SHELTON, WA 98584
SEPTIC INSTALLER LOGAN SPEAR* Phone: 360-427-4440
Address: 2000 W SHELTON VALLEY RD SHELTON, WA 98584
Site Address: 701 E LAKESHORE DR EAST
Primary Parcel Number: 220175200085
Permit Description: Replace septic tank
Permit Submitted Date: 03/01/2024
Permit Issued Date: 03/04/2024
Issued By: Rhonda Thompson
Current Permit Fees Paid: $265.00 (additional fees may be required upon installation of system).
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Permit Expiration Date: 03/04/2025 (based on date of inspection)
0 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: Public Water System
Additional Details: Roth 1250g
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.govlhealth/environmental/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
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DAI E RECEIVED: r ��
MASON COUNTY `
COMMUNITY SERVICES AMU THE EIVF�+ ` ` I=LCENE E CO rn
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Public Health(Community Health/Environmental Health) ^ - O
415 N 6thu7Q,ext.t00 t n. 2754467,ext.400 SWG
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415 N.6th St�cM-Shelton.WA 98584 V\V/IV� �(J Y V U U,Vr..1/ � 5
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ON-SITE SEWAGE TANK ONLY APPLICATION m n
PHONE m
APP.-ICAN7 r
John Peppers Z
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MAILING ADDRESS-STREET,CITY,STATE:ZIP CODE — W
701 E Lakeshore Dr E Shelton Wa 98584 _ c m
SITE ADDRESS-STREET,CITY,ZIP CODE
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Same as above coN
CD
NAME OF DESIGNER PHONE (n I N
NAME OF INSTALLER PHONE J D
Logan Spear 360-239-1541 <_
TYPE OF WORK(select one) DRINKING WATER SOURCE O
❑ NEW CONSTRUCTION/UPGRADES ® REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z i
0 PUBLIC WATER SYSTEM TimbeFlakes
COMPONENT(S)TO BE REPLACED!INSTALLED —I 1
II1 SEPTIC TANK ❑ PUMP TANK ❑ RV HOLDING TANK BEDROOMS LOT SIZE O I 01
❑ OTHER 3 .3 acres
O N I
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST
I
ElSURFACING SEWAGE ®EXISTING FAILURE 0 SHORELINE ❑I 100FT+PUBLIC!COMMUNITY WELLS 0 I O
SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
SUBMITTALS
CI PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) I 10FT+DRINKING WATER SUPPLY LINES I O
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) ® 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
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PLOT PLAN CHECKLIST 0 I O
I] PROPERTY LINES AND EASEMENTS III EXISTING!PROPOSED STRUCTURES ® EXISTING!PROPOSED OSS COMPONENTS AND LINES
II WELLS WITHIN 100FT ® WATER SUPPLY LINES ® DRIVEWAYS/PARKING ® SURFACE WATERS,STREAMS,RIVERS,ETC... OD
I CO
® DIRECTION OF SLOPE/CONTOURS IIIIII PERIMETER/CURTAIN DRAINS m NORTH ARROW ® SCALE BAR 01
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gale)
Take WA-3 N and E Agate Rd to E Timberlake Dr
Take E Herron Dr/E Lakeshore Dr W to E Lakeshore Drive East
701 address on left
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:
COMMENTS!CONDITIONS
Q__becoc ,e,10-c- (__ 4e ily:-
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 APPLICATIO�PIR/ITION DATE APPLICATION APPROVED!ISSUED BY DATE
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-- 12 ...----- iSNl-7.5-r
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12f7/2015
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