HomeMy WebLinkAboutBLD2014-00727 Replace SFR - BLD Permit / Conditions - 8/28/2014 Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County Bldg. III 426 W. Cedar P.O. Box 279
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2014-00727
OWNER: SEAN DEREK-ALLEN RECEIVED: 8/8/2014
CONTRACTOR: IMPERIAL HOMES SALES INC (760) 995-3204 LICENSE: IMPERHS952JN EXP: 4/15/2015 ISSUED: 8/28/2014
SITE ADDRESS: 320 E KUHN AVE UNION EXPIRES: 2/28/2015
PARCEL NUMBER: 322325050035
LEGAL DESCRIPTION: UNION HOOD CANAL LAND & IMP CO BLK: 50 LOT: LOT 35-40 VAC KUHN AVE &ALLEYADJ
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
REPLACING SFR WITH NEW MANUFACTURED HOME UNION
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type of Constr.:
Type of Use: MH Insp.Area: No. of Bathrooms: 2 Occ. Group: R3 Lot Size: Deck:
Type of Work: NEW Fire Dist.: 6 No. of Stories: Occ. Load: Building:
Valuation: Building Height: Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
Make:Karsten Length: 56 Ft. Front: S 15.0 Ft. Shoreline: Ft. Water Body:
g SEPA?:
Model:SP28566 Width: 27 Ft. Rear: N 95.0 Ft. Slope: Ft. Shoreline Desig :
Side 1: E 5.0 Ft.
Year:2014 Serial No.: TBD Side 2: W 60.0 Ft. Comp. Plan Desig.:
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Manufact. Home Submittal TW 8/8/2014 $264.25 S2201400000001
Planning Review Fee TW 8/8/2014 $205.00 S2201400000001
Fire Warden Review TW 8/8/2014 $73.00 S1201400000001
EH Plan Review TW 8/8/2014 $ 100.00 S2201400000001
EH Plan Review TW 8/8/2014 $ 100.00 S1201400000001
Manufact. Home Issuance DLC 8/26/2014 $264.25 S1201400000001
Total $ 1,006.50
BLD2014-00727 Please refer to the following pages for conditions of this permit. Page 1 of 6
CASE NOTES FOR
BLD2014-00727
CONDITIONS FOR
BLD2014-00727
1) A Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more information contact Public Works, at
(360)427-9670, ext. 450. The building permit will not be"finaled" until the permit holder can show proof that the access permit from Public Works has
been "finaled".a approved.
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2) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-64,ZQ9822. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
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3) Owner Unti�responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
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4) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered.
A. Drainfield/ Reserve requires a 1 Oft setback from all footing/foundations.
B. Septic tank(s) requires 5ft setback from all footing/foundations.
C. No ation drains within 30ft, down gradient of drainfield/reserve area.
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5) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will
not be granted. I��nt�addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
Xepartm�`fo any further inspections being performed or approvals granted.
6) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the
corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building
Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or
remova��proved documents will result in failure of required building inspections.
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7) THE FO TION SYSTEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL.
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BLD2014-00727 Please refer to the following pages for conditions of this permit. Page 2 of 6
8) The "approved" site plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved" site plan is not on site, then
approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the
Xuilding Dep l nt prior to any further inspections being performed or approvals granted.
9) Any retailer, manufacturer or contractor who installs a manufactured home warrants that the manufactured home is installed in accordance with the State
Installation code, chapter 296-150M WAC. All installers hired to do installation work shall be certified manufactured home installers and shall be present
to supervise the installation of all on-site work. An Installer Tag shall be posted on site giving the certification number and signature of the certified
installer responsible for each major part of the installation. RCW43-63B.090
An approved Installer cerification tag shall be placed on the end of the manufactured home directly above or below the HUD certification tag or temporarily
located in plain site within three of the home's front entry. There shall be one certification tag for each certified installer accounting for the work that each
installer performed or irlstalled. certification number and signature of the certified installer responsible for each major part of the installation.
WAC365-210 X t -3 t
10) If you are installing a manufacturing home and no longer have the installation manual for the home, you must use the instructions of the American
National Standards Institute (ANSI). To order the ANSI instructions you may either get an order form from the Mason County Building Department or you
can contact tpo ice of Manufacturing Housing (360) 725-2800.
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11) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement,
inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the
owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel
prior to the commencement of any development activities. "NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater
Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan" constitutes
an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are
responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system
of this, or any other, parcel. You may also wish to consult with the septic design professional involved with the project. By calling for a final inspection of
the building permit the owner/agent/contractq&i knowledging that all components of the stormwater management system have been installed as
.0 approved on the stormwater site plan. X t �L7
12) A concrete encased grounding electrode must be installed and used at each new building or structure that is built upon a permanent concrete foundation.
In Mason County the electrical code is regulated by Washington State Department of Labor& Industries (L&I).
For more information contact L&I for additional information. In Olympia call (360)902-6350 and in Bremerton call (360)415-4000.
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13) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the
State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit revomfiram
BLD2014-00727 Please refer to the following pages for conditions of this permit. Page 3 of 6
14) The demolition and disposal of debris must meet the regulations of Mason County and Olympic Region Clean Air Agency (ORCAA).
It is unlawful for any person to cause or allow the demolition (or major renovation) of any structure unless all asbestos containing materials have been
identified and removed from the area to be demolished. Work shall not commence on an asbestos project or demolition project unless the owner or
operator has obtained written approval from ORCCA.2490 B Limited Lane NW, Olympia WA 98502, 360.586.1044/800.422.5623 www.orcaa.org
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15) REQUIRED INSPECTIONS (Footing Inspection-prior to pour, Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I hereby assume all
responsibility for the scheduling of my required inspections. If the required inspections are not requested, inspected and signed off(approved) by the
inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the current fees adopted by the Mason
County Building Dept., and will be assessed in addition to my original permit fees resolve any questionable practices or problems that have been
discovered. I further understand that this investigation will be sch d as ows. Until resolution of any/all problems no occupancy (Final
Inspection)will be granted for the residence.
OWNER/CONTRACTOR(indicate which) Signature X
16) This permit is for the and installation of the manufactured home only and does not imply approval or review for any other items indidcated on
the plot plan. X
17) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact
adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the
stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further
information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access
connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which
is proposed to be located within 25' of a Mason County road right of way, it is suggested to contact that office to review future planned work which may
affect your project.t
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18) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinanMtulation, must be reviewed and approved by Mason County prior to construction.
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19) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED
BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector made prior to requesting additional inspections.
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20) All property lines shall be clearly identified at the time of foundation inspection. X
21) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure
to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with
Mason C dinances and building regulations.
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BLD2014-00727 Please refer to the following pages for conditions of this permit. Page 4 of 6
22) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for
action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder have t d action from being taken. No more than one extension may be granted.
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23) Retaining walls needed to support a surclhrgE,such as structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall.
24) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR ROA Y.
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25) The approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical report or assessment. All
applicable recommendations and specifications shall be applied to the development on this site. Any deviation requires stamped written approval from the
registered design professional responsible for the report/assessment, and may require special inspection by same. Structures and/or land modifications
(grading, cuts, fills, etc.) required in the geotechnical report/assessment, may require a separate permit. The geotechnical report/assessment shall
remain d to the approved building plans.
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26) Approved "mensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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27) All construction and demolition debris must be removed from the site after project completion. Pr i posal of construction debris must be on land in
such a manner that debris cannot enter or cause water quality degradation of State waters. X �,
28) Concret�l�ae ate and wash water must be contained during construction pouring, such that water quality degradation of adjacent waters does not occur.
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29) Temporary erosion control measures must be implemented to prevent water quality degradation of adjac(Mit ,ers or properties. Silt fencing, straw, or
surface matting must be installed and maintained until upland vegetation has become established. X ��
30) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these structures meetthe setback conditions listed.
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31) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approved Sit Va ".to ensure these structures are shown and meet the setback conditions listed.
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BLD2014-00727 Please refer to the following pages for conditions of this permit. Page 5 of 6
OWNER/ BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by
signature below. I declare that I am the owner, owners legal representative, or contractor. I further declare that I am entitled to receive this permit and to do the
work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The
owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s) for review and inspection. This permit/application becomes null &void if work or authorized construction is not commenced within 180 days or if
construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLI 10 F 18 DAYS WILL INVALIDATE THE APPLICATION.
Signs ure Date
L old OWNER - REPRESENTATIVE - CONTRACTOR
Prin ame (Circle one to indicate)
BLD2014-00727 Please refer to the following pages for conditions of this permit. Page 6 of 6
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o CONCRETE MECHANICAL MANUFACTURED HOME M
o Date By
ill Footings ISetbacks Gas Piping Ribbons M
o Interior Date By Interior•Date By Date
N Extenor Date By Exterior-Date By Set-up �
INSULATION
Point Load!Isolated Footings Date �2 -J m
BG!SLAB INSULATION By Z
Date By Data By FIRE DEPARTMENT N
Foundation Walls Floors Date By D
Date By Data By DECKS Z
FRAMING Walls Delta By
Date By Data By PROPANE TANKS
PLUMBING Vault Date By
Date By OTHER
Groundwork Attic
Date By Date By
Type:
Date By
13MV DRYWALL Type-
Int.Brace Wall Date By 03
Date By Date By _ r
m FINAL INSPECTION _ _____ 0
mWater Line Fire Seperation N
Date By Date By Dal B _ O
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o Pass or Request Inspect. c
Type of Insp. Fail Date Date Done By Comments N
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Permit# 41-Z' MASON COUNTY
BUILDING Ill 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location J;42 C Atfk2 AA
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items listed below must be corrected to gain compliance
�f= aezd L4a& �
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing ❑ please contact our office
Make corrections, items will be checked on next inspection regarding possible structural
❑ OK to damage incurred by recent
"natural/man made"
❑ This is not a complete inspection disasters.This is NOT a
Date - z -/z Department CORRECTION NOTICE.
Inspector l21/2L�(
I
n* " N* ,0T i '���1 �4 ' THI , TAvm * Mw
cock
MASON COUNTY PERMIT NO.
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING• PLANNING•FIRE MARSHAL
WWW.CO.MASON.WA_US (360)427-9670 Shelton ext.352
Mason County Bldg. III,426 West Cedar Street (360)275-4467 Belfair ext. 352
txsa Shelton,WA 98584 (360)482-5269 Elma ext.352
BUILDING PERMIT APPLICATION X'�
OWNE ORMATION: / CONTRACTOR INFORMATION:
NAME: 1 i /'n� F'1 NAME: 2WNCJ wle5
MAILING ADDRESS: 31 MAH, XODRESS: /.2�Z � Ste/'
CITY: Unlaw STATE: q ZIP: CTI'Y: hA 1( STATE: � ZIP:'
PHONE: CELL: PHONE• �777 CELL:
EMAIL: EMAIL :
L&IREG#,rnj9&rh5
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) FIRE DISTRICT
LEGAL DESCRIPTION(ABBRUFVIATED) : DIK W 110+
SITE ADDRESS �, (� CITY Unicio ` ztl
DIRECTION TO SITE ADDRESS X) ' i01 . 41ic ` el 7;r / Jl v
o
IS PROPERTY WITHIN 200 FT: k-�t;►�� h !3 �t��4�/r1�
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL R OFF IN ❑�-, M ❑S �A
DOES PROPERTY HAVE SLOPE(S)WITH 300 FT OF THE PROJECT-GREATER THAN 14 Y�Es k 50
TYPE OF JOB: NEW ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER ❑ f�I4CPf11E,1i
USE OF STRUCTURE .n GARAGE ETC.)
IS USE: PRIMARY SE SONAL❑ NUMMR OF BEDROOMS NUMBER OF BATHROOMS —
DESCRIBE WORK''0t' Cir'Y ('P I�i�sty t'>! ��nC, �ImNe 2es► Nc 3 /5�5 tl1.����r
SQUARE FOOTAGE:
1 ST FLOORJjr sq. ft. 2ND FLOOR sq.fL 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq. fL COVERED DECK sq.fL STORAGE sq.fL OTHER sq. fL
GARAGE sq,fL ATTACHED ❑ DETACHED ❑ CARPORT sq.fL ATTACHED ❑ DETACHED ❑
MANUFACTURED HOME EWORMATION: *4 COPIES OF THE FLOOR PLAN
MAKE �'jLiF`S��ry. ODEL "0�0 d�p YEAR�L�/�{ `�GTH (C�f
WIDTH BEDROOMS BATHS SERIAL NUMBER
OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or contractor. I further
declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary
parties, including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for
review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if constructi ork is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF
IN CTI _ F T IS PERMIT AP LICATION OF 180 DAYS WI lNV DAT HE APPLICATION.
X ! —
ignature f ica Date
OWNER/ PRESENTATfV CONTRACTOR
Print Name CIRCLE TO INDIC E)
DEPARTMENTAL REVIEW APPROV D DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENTy y Oka)
PLANNING DEPARTMENT
FIRE MARSHAL
ACCESS & GRADE INSPECTION BLD ZD I H-0079"i0c�0
ADDRESS: - 32C1 �✓ 6�\A
INSPECTOR: I.�V� DATE OF INSPECTION:
FIRE SPRINKLER REQUIRED? (circle)( YES
IF fire sprinkler required, was notification letter mailed? DATE MAILED:
DRIVEWAY ACCESS
( ) need post at access of driveway with reflective address numbers
Length: Width: Surface:
Size of turn-around:
Condition of shoulde s:
Vertical clearance:
GRADE OF DRIVEWAY %, OF ROAD %
ROAD ACCESS
Length: id Surface:
Condition of Shoulders
Vertical clearance:
(� BURN PERMIT REQUIRED FOR LAND CLEARING FIRE.
(_) LOT INSIDE UGA—NO OUTDOOR BURNING PERMITTED.
LOT TOO SMALL FOR: BURN PERMITS 4 X 4 FIRES
2 X 3 FIRES
PASSED ( ) FAILED ( ) ON HOLD ( )
REMARKS: �� ��s (��•C�
-PLANN IN M
ALL SETBACK'S caPF f4EASURED _ M
- `
FROM THE FURTHEST - 4
-
PROJECTION OF THE BUILDING
APPROVED
MASON COUNTY DCD PLANNING
SITE PLAN REQUIRED TO 13L ON SITE
CHANQES SUBJECT TO AF PPROVAL r
By Date r7 V
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P }RCE� t 3��3� soSo03s' : D' ae' 40
♦ TEStr BOLES
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Name- ' ) ('C' I� Parcel# 3-?),V iQ �`'��� BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page I of 2)
Per Mason County Code, Tilde 14,Chapter 14.48 a stormwaxer site plan is required whenever a building application is
made for residential development,or redevelopment',with more than 2,000 square feet of impervious surface.
'`Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,stmcbmal development
including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
'Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel wads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural iri ltr-zition of stormwatea.Open,uncovered retcntion/detention facilities shall not be considered as impervious surfaces.
_ _ _.T�-.�aTcr�late:Irn ��vs`Suffices-�l�as�;troi#i T�s 'F�b1,e`';'��`?A�::,�-� �:�_:- •:�;-
Surface Type Length X Width = Area `All dimensions in feet
Buildings X = ��
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways IcA X /
X = Length of drive begins at the right of way
X
Parking Areas X =
X = Any paved, gravel or packed area per definition
above table
X =
PatiosMfalks d X JO
X = Any paved, gravel or packed area per definition
above table
X =
Others X -
X = 'tf.the total'impervious area-of the proposed tits
X = developmei is.-greaterthan.2DD0•square feet s
Small?arcel:Stormwater:Site.Plan:i5 Required.:.
Total Impem- ous.S oe Area(sum-aft areas)_ OL
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet; please read,acknowledge and sign below.
Based Upon the information you have provided a Starmwafer Site Plan IS NOT required for this development activity.
OAmerBuilder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
descnbed property for review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet, please read,acknowledge and sign
the information provided on page 2 of 2.
Page 1 of 2
Name Parcel 4 BLD9
Mason County
Department of Community Development
Small Parcel Stormwater Management ApplicationiWorksheet (page 2 of 2)
Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14, Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater
Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
httD//�A'ww.co.mason.wa--us/code/commissioners/mdex.htm
Please follow the links to "Title 14, Chapter 14.48 Stormwater Management".
Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan
(Mason County Code Title 14 Chapter 14.48.section 14.48.70). You will receive a copy of the Public Works document
entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan".This document will assist.
you in preparing the necessary information and plans for Public Works to review and approve. Per Department of
Public Works this document will constitute an approved plan if all of the relevant details*are to be installed in
their entirety AND no part of the stormwater system adversely affects any septic system (see Environmental Health
information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan
on the pages that begin with"Handout"
PLEASE DgTITAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A) ✓ ;e relevant dctarls from Managing Storm Drainage on Small Lots,The SmaH Parcel Stormwater Site Plan will be installed
in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples. (Section 14.48.130)contact Public works at:
Phone: (360)-427-9670 EXT.450
Mail:P 0 Box 1850, Shelton WA 98584
Physical:415 N 6th St,Shelton WA 98584
If this development has, or will have,a septic/drainfield system you may need to contact Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or
any other, parcel. You may also wish to consult with the septic design professional involved with the project Mason
County Division of Environmental Health can be reached at:
Phone: (360}427-9670 EXT.352
Mail:P 0 Box 1666, Shelton WA 98584
Physical:426 W Cedar St, Shelton WA 98584
A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met
prior to a request for fmal inspection of the building permit
OwnerBuilder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
%knowledge th o ation provided is accurate and employees of Mason County are granted access to the above-
Cnbed pope for evi and ' ection as may be required.
11 Owne/ etn�t/�n (circle one)Date:
Page 2 of 2