HomeMy WebLinkAboutSWG20223-00534 - SWG Application / Design - 12/28/2023 .01, MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
RELFAIR:360-275-4467,EXT 400
..1— Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX: 360-427-7787
On-Site Sewage System Tank Only Permit: SWG2023-00534
APPLICANT FAWN LAKE MAINTENANCE
COMMISSION Phone:
Address: 471 SE CRESCENT DR SHELTON, WA 98584
OWNER FAWN LAKE MAINTENANCE
COMMISSION Phone:
Address: 471 SE CRESCENT DR SHELTON, WA 98584
SEPTIC DESIGNER CINDY WAITE-Septic Designer Phone: 3607010205
Address: 80 E PICKERING LANE SHELTON, WA 98584
SEPTIC INSTALLER 5 oeni Lc.v u.}-+ncJ� k c, Phone:;foo • 142 ZG B
Address: I21 Vu 6-Y7%-Z- ale. r Sh.(l�ov\
Site Address: 220 SE CABANA AVE
Primary Parcel Number: 319045300001 O (� M [ L
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Permit Description: Replace septic tanks I j
Permit Submitted Date: 12/28/2023 MAR u 8 2024
Permit Issued Date: 01/16/2024
Issued By: Rhonda Thompson By
Current Permit Fees Paid: $255.00 (additional fees miry be required upon Installation of system).
Permit Expiration Date: 01/16/2025 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 0 Drinking Water Source: Public Water System
Additional Details: Septic tank
Permit Conditions:
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
4 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND/OR DESIGN
APPROVED,
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.gov/health/environmental/onslteloss-inspection-request.php or call:
µ x ..7r9 ? i extension 400.
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ON-SITE SEWAGE TANK ONLY APPLICATION n n
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FAWN LAKE MAINTENANCE 1 360-701-4055 z
t.IAILING ADDRESS•STREET CITY STATE 2:P CODE ---'—'-—- - —
471 SE CRESCENT DRIVE C
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COMPONFNT(S.TO BE REPLACED/INSTALLED CI PUBLIC I A7 FR.$Y$Ti I r�'iiN ulKfc':';S Z
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• PLOT PLAN(REQUIRED) ❑TANK CROSS SECTION(REOUIREU; le I OF Tv 3t NKIN(;WA.-ER:;IJPI;.Y:.INE i
® PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) I I. .FTI PROPERTY.EASI.:;IhNI :!NES FOIIN!),.1ioNs 1 3I)1IIJ•3S CI
Ft OT P..0114 CFCCKLIST '—- --- — ----
MI PROPERTY LINES ANDEASEMENTS U EXISTING/PROPOSED SrRUCTURES III E.XI$!IN:;:PIti;-':;:;I_:;i1ST,CLL.;'i NI-N:S AND LINES O O
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!)IRECTW 1'AS USITIANDSITECONDITIONS Id" eUpa:e, _. .._ ........ y
GO OUT COLE ROAD, TURN RIGHT INTO FAWN LAKE, TURN LEFT AT TEE ONTO
CRESCENT, TURN RIGHT ONTO CABANA, PARCEL IS AT END.
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I IPCRADE 1 FAILURE SOURCE thN'coxing Purposes;
❑VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE L]COMPLAINT 0';IFIER.
COMMENTS!CONDITIONS -�-: •--. _ —
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Sr.t1tAGI.TANKS MUST BE LISTED UNDER DON US-Of NEGI8IF.REI)SEWGF TANKS TANKS MIST•.I1_IC.,-Ri-VTI:pig.;:.'+::'v:;IN(11,t•.-FI.;I - ;.r11•-I.1.'•1 t.'iIP;1fit;
AND LIDSTOSURFACE AND INCLUDE AN EFFLUENT FII TER;IF APPLICABLE. RCC0Nf1URAl`JINUANI: N,;IAl:...l'.:N:I;F.P•),<';:Ii:;_,1•t!I;I.•F:: ;
INSPECTOR SIGNATURE DATE APPLICATION EXriRATION DATE "1 • --
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Printed NMI o_1 county , r'S ►:r.:.•::.1•t. ..
Cindy Waite
80 E Pickering Lane
Shelton, Wa. 98584
360-701-0205
December 27. 2023
RE: Fawn Lake Maintenance
220 SE Cabama Ave
31904-53-00001
This system has two failing 1000 gallon tanks. We are replacing the tanks with a 1500
gallon tank with risers and effluent filter. This system has minimal use, it is in use from
Memorial Day to Labor Day with 1000 to 1500 gallons per month. There may be a
couple events in the off season for only one day.
The system will be retrofitted with a D-Box and riser for better observations and
maintenance of the system.
Respectfully submitted;
Wait
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APPROVED
JAN 16 2024
MASON CDUNT1'EYviRCNYENi!,11-1Ef.1114
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Printed ro Mason County O
THURSTON-MASON HEALTH DISTRICT No. _ 3 1 1
• Division of Sanitation
eourt Rouse Annex Court Hasse annex
- -- Olympia, `Tashington
• Shelton, "Tashington �" � .// phone 352-4851
Phone 426-851.5 3 I gQ ci-53- woo
APPLICATION TO CONSTRUCT OR ALTER AN INDIVIDUAL SEATAGE DIS AL SYS't'EW
(Application required for each installation)
Property Owner Fa.us, L..Ale.. c\• P r.dia. . Telephone
(Please Print ..
Mailing Address F,,..,., L.t ._
Address of Site 5�.,..+e.,
Oche,/ , --r---�__
Location of Property, including: Lot I Block,,` ee
Detailed directions to site:, ' — iJ L Crf4B'
�a� �� � �
Cameral,
Pronertx Basement_ _,,Type
Ape Residence No. Bedrooms
tTat Supply:- 5)016, '..'ell Spring ,�,�Other t
Is any water supply or body of water within 50 feet of sewage ayatea? Yes_i
Septio 'Z.t \°°°gallons. Drainage stem Length eet. Tren$h 1lidth,,et.'
(Refer to T' le 1 of Bulletin) (Reefer to Table 2 of Bulletin) ,
And/or system other than above f
Cheok for Installation of: Garbage Grinder ( )
Automatic Laundry { ) Automatic Dishwasher ( ) -
Is Contractor installing septic 'tan % yes-"-.1 No Drainfield? 'yam+ no
Name of Sewage Contractor Q ofA3- k.b --- ton-Mason Sewage contractor must be licensed by ' hers ..
Health District
SKETCH PLOT PLAN AND PLANS OF PROPOSED SYSTEM ON SEPARATE SHEET OF PAPER
THE UNDERSIGNED hereby applies for a permit to .construct a new and/or ': 'ao l .
alt6r ( ) a sewage systes� sx tisv �r ! in accordance with the Da etin.
. ` . Applicant's Signature 1L;�, ) K.
Address_--2.� 3 5_ o Y _. y 7% L.__ ._. __S\._,.\V'•.t -- _ . _._ --- - __
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Bulletin 1Tashinaton State Department of Health Bulletin -."3. Na. 1 entitled
. Septic Tank -system for Your Home for minimum requirements.
_ __ _ .- - "( of to be filled in bi A 01; icwnt) - --- - _ - r_ -
Permit No ,*4i& Fee L"_ Date Issued f►_ By 'f1(.
Area ---__ .___. . . _ . . - Sanitarian_ - __ _---
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Dates Inspected_ - . __ _ . __ - _ __ . . __ . _ __ Rem:�rks_w-____________- ._.__._. _ ._ -_____.____._._
Approved B� '
Date Approved _ .��-�'- �_. _.p. ,� _ __.___.._-----
1 Sanitarian^
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Printed irorn Mason County DMS
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No. L�G`�
5th.& StrohThurston-Mason- Health District Court House Annex
Shelton, Washington DIVISION OF SANITATION Olympia, Washington
Phone: 426-4407 4112jpN400I /,. $ , COK Phone: 352-4851
(Submit i it'
DO NOT WRITE IN HEAVY OUTLINED SECTIONS
Owner Pa.AJJ.IV h R k4-,- Phone tt
Mailing Address .Rt..3 City ...S.ka.4t+ ^I State _ .t A -La..
Builder tt Address
Sewage Contractor .11be.A3n.....•1•}•0 .Q• +.0- Address ...RA.._.1 8.0,c U-►i A
Legal Description Lo# •\ Am, y c.0..0.1.14 Lek
Parcel No. Field Book No.
Directions to Property Fa4,t h \PsQ-•cA-i \
Intended uses of Buildings l30.k... .u4.t..•••Public Sewer Water Supply P1Mo
No. of Bedrooms No. of Bathrooms Basement. Septic Tank
Type of Soil Lot Size
Soil Drainage: Good Moderate Poor None
DRAW SKETCH in blank space or on separate sheet indicating the following:
1. Property lines and location of house on lot and indicate minimum and maximum setbacks plus
dimensions of lot and all buildings.
2. Location of house and sewage disposal system in relation to streams, lakes, wells, patios,
driveways, underground tanks, water supply lines and easements.
3. Location of all interception drains or french drains.
4. Proposed fill, including depth, area, porosity and amount.
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APPLICANT'S SIG ATURE DATE 1
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A.ircr'�t er ::+ - rt „efikI V DATE SANITARIAN