HomeMy WebLinkAboutCOM2016-00062 - COM CD Environmental Health Review - 4/20/2016 MASON COUNTY PUBLIC HEALTH OFFICIAL USE ONLY
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ENVIRONMENTAL HEALTH REVIEW yyx\rt ar°a"aw
415 N.6M Street Shelton,WA 98W '
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(360)427-9670,Ext 400 (360)275i 7.Eat 400 MWD
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2.Type of Review/Job 3.Job75ite Information
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[IResidential ❑ Commercial �TennaM Review
❑ New ❑ Replacement Pre-Application + _
❑ Remodel ❑Addition ❑Other(expl 'n below) �,mrat- F sseww nwr.4—
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4.Ore-She Sewage SydetNSewer Information
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❑ Sewer ❑ New ❑ ..ng S.Water Source Information
Tama xam+vwx.aal FA.mcssribing in structure? 'T Yes [I No
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Using an existing omsne septic spasm"I"itlre acvmm maintenanu report ase submit a corn pleted Water Adequacy Form.
aMaRecord Drawin(kbuft Documemz for hothoftheeersqupremena may ale submitted Water Adequacy Form may be
tecn6pawBhuaaooCour4yPNbrctlehh.Odelacniemems,nsyaPPly urned,and hold up review process.
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A scaled She Nan Is required with a1I permhs,except Interior remodels.An incomplete wbmhted site plan may be returned,and
hold up review process. Paper sbefor site plan can be 8.Sx11,&Sx14,or 11,07(max). Nease use dteddist below:
❑Propertylines/dimensions ❑Primary Dralnfield area EIReserve Drainfield area ❑Existing/proposed wells OWaterlines
❑Septic Tanks location ❑Location of curtain/perimeter drains ❑Direction of Slope ElDnveways/Parkingareas/Fasements
❑Existing Structu Proposed Shuc ❑Sewer lines/tanks Additions ❑NOnh Arrow ❑Scale Bar
Applicant Signal Date
Ofhdal use only —�
Departmental Review Approval Ind& Date Notes,Cond@IonA Related Permits
Water Adequacy
Sewer/Septic System ,� 1
Tenant Review
Revision
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBUCVIEW ONTHE MASON COUNTYWEBSITE er4setivsavls
Mason County Map C3utput Page ��' ' • ��� Page 1 of
ENVIRONMENTAL
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••• DISCLAIMER AND LIMITATION OF LIABQ.ffY:
The data used to make this map here been mntN for mcvracy,end every effort has been
made to ensure Watt n sdmaere timely,s- ,sn,end oaRble.newever.Mamn County LEGEND
locationo£any on,features wntnimd berein.The bomdeues depicted by toes,data arc R9ads foCoral w4s
spproxbmte,un,are mt necessanly ewomte to survs mog or engineering standard,and ere H'Onays CRYOISh.wo
inteMM fw infomarionel purposes only.Meson County does mt assume any legal liability �-1
orrespomibtliry ensing from the use ofthis map inamnmermtinteuded by Mason County. -�. R. er,a Screams t_f Cowly B9uMary(oMRI
In no overt shell Meson County be heble for drtc int irect,incidenml,consequential,
special,or but annoy aofnry kind,including but not limited to,loss ofantnipared profits parosis commisworei❑smofs
or bcnefiu arising from use of or relimce on tha iM'ormelim wnmined herein
Sections f Lakaa
r '�a 03009-Mason County GIS Ta sbgs f Ru9N Sound 6 Moor Lakes
WO W.Nblic Works Dr
Shelton,WA WS
RECEIVED
APR 2 0 2016
6 i o W. Alder Street
hth,-//mRmnacnn Gn mason wa Ile/Rervlet/rnmecTi ecrimanRcriman?CerviceNnm�smscnn... 4/20/2016
1871 E Johns Prairie Road
Shelton, WA 98584
Phone 360-426-6697
Fax 360-426-0330
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,''; Island Johnny, LLC
April 29, 2016
Mason County Health Dept
PO Box 1666
Shelton, WA 98584
APR 2 9 2016
RE: Parc# 12108-21-00032j
To Whom It May Concern:
1„Rob Goodwin, installed a Riser on the Septic Tank, a High Water Float
and provided John with an indoor Alarm. John Maynard dug up the pipe to
the existing tank and capped the pipe about a foot out from the tank. He
hooked up the alarm inside the building and provided a signed pumpers
contract between the Grapeview Loop Store and Royal Flush.
S ncer ly,
Rob Goodwin
Island Johnny, LLC
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