HomeMy WebLinkAboutSWG2024-00139 TANK ONLY - SWG Application / Design - 4/9/2024 415 N 6TH STREET,SHELTON WA
MASON COUNTY e6400
SHELTON:3fi042]-9670,EXT 400
Public Health & Human Services BELFAIR:360-2754467,EXT 400
ELMA:360482-5269,EXT 400
FAX:360427-7787
On-Site Sewage System Tank Only Permit: SWG2024-00139
OWNER GOMEZ-MIER ET UX JOSE LUIS Phone: 863-244-0854
Address: 155 E DELANTY RD SHELTON,WA 98584
APPLICANT Sam Skinner Phone:
Address: PO Box 920 EAST OLYMPIA, WA 98540
SEPTIC INSTALLER SAMUEL SKINNER` Phone: 360-536-7678
Address: PO BOX 920 FAST OLYMPIA,WA 98540
SEPTIC DESIGNER ADAM HUNTER' Phone: 360-753-1226
Address: PO Box 162 OLYMPIA, WA 98507
Site Address: UNKNOWN
Primary Parcel Number: 220295099043
Permit Description: Replacement dosing tank for community OSS
Permit Submitted Date: 04/09/2024
Permit Issued Date: 04112/2024
Issued By: Rhonda Thompson
Current Permit Fees Paid: $265.00 (add¢onai tees may W required upon installeaon aeysram).
Permit Expiration Date: 04/09/2027 (bssed on dens of Inspecuon)
Type of Work OSS Repair
Components being Replaced: Pump Tank Only
Surfacing Sewage? Yes Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 18 Drinking Water Source: Private Well/Spring
Additional Details: 1000 g dosing tank
Permit Conditions:
1 Horizonta/setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
3 Mason County Asbuilt Farm, Record Drawing, and Installation fee must be submitted for
final installation approval.
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.
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/environmentagonsiteloss4nspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
DATENOS.TO:
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TYPEOF WORK(mM[ .) CPoNKING WATERSWRCE N
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O NEW CONSTRUCTION/UPGRADES EREPAIRIREPIACEMENf OPRIVATE INDIVIDUAL WELL � PRNATETWD-FARTV WELL 2
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0 PUMP DETAILS(IFAPPLICABLE) O WAIVER(S)(IFAPPLK:ABLE) SFTFPROPERTYIEASEMENTLINES,FWNDATIONS,FWTINGS Fri'
PLOT PWI CHEOIQIST 0
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E DIRECTION OF SLOPE/CONTOURS ■ PERIMETER/CURTAIN DRAINS ENORTHARROW IIIII SCAIE RAR
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SE AAOETAM03 MUST DELISTED TINDER DOH 1USTOF REGISTERED SEWAGE TANKS'.TANKS MUST MEETCURRFNTMINIMUM SITE REQUIREMENTS,EQUIPPED W111i RISERS
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC NEW ON THE MASON COUNTY WESEDE REVISED IEPRDI5
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