HomeMy WebLinkAboutSWG2024-00324 - SWG Application / Design - 7/30/2024 SHELTON,WA
MASON COUNTY 4i5N8SHELTON: , 0427-97 ,EXT 400
SHELTON:360d27-9870,EXT 400
BELFAIR:360-2754467,EXT 400
Public Health & Human Services ELMA:360482-6269,EXT 400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2024-00324
OWNER MCREYNOLDS CHARLES H &CYNTHIA Phone:
Address: 240 SE CHANNEL PT RD SHELTON, WA 98584
APPLICANT MCREYNOLDS CHARLES H &CYNTHIA Phone:
Address: 240 SE CHANNEL PT RD SHELTON,WA 98584
SEPTIC INSTALLER SHANE MAPLES` Phone: 360-463-8474
Address: 911 SE Arcadia Road SHELTON,WA 98584
Site Address: 240 SE CHANNEL POINT RD
Primary Parcel Number: 320255000059
Permit Description: Add lift station
Permit Submitted Date: 07/30/2024
Permit Issued Date: 07130/2024
Issued By: Rhonda Thompson
Current Permit Fees Paid: $265.00 (additional Nos may be regmied awn msmneuon o/snmm).
Permit Expiration Date: 07/30/2025 (based on dale or insyedon)
Type of Work OSS Repair
Components being Replaced: Other
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? No
Number of Bedrooms: 3 Drinking Water Source: Private Well/Spring
Additional Details: Roth 500g lift station
Permit Conditions:
3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
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 staffper Mason County Title 17.
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
5 Must install Roth triple walled tank.
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/environmentallonsite/oss-inspection-mquest.php or call:
360.427-9670,extension 400.
OFFICIAL USE ONLY
® MASON COUNTY OM MEND ' 30 - N D
COMMUNITY SERVICES
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TYPE OF WdIX(ml.—R DRIWING WATERSOURCE J�
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COMPONENT(S)TO BE RE1PyACEIN INSTALLED L3 PUBLIC WATER SYSTEM
O SEPTIC TANK YI PUUM�P,Ffi � LOi3� A�TANK 0RVHOLDINGTANK BEDROOMS f, I I ,
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OTTER CETAYS(eMM Mtlat sq+'yJ T.RI)SETBACK CHECKLIST 6
❑SURFACING SEWAGE ❑EXISTINGFAILURE OSHOREUNE FT.PUBLIC COMMUNITYWELLS 0
SUBMITTALS +PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS O
P�LLLOT PLAN(REQUIRED) $TANK CROSS SECTION(REQUIRED) /�Ery FT.DRINKING WATER SUPPLY LINES
GI4UMP DETAILS(IFAPPLICABLE) ❑WAIVER(S)(IFAPPLICABLE) tp BFT.PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS I v
PIAT/P4N CHECKLIST Q I C
42rPROPERTYLINESANDEASEMENTS TEXISTINWPR EDSTRUCTURES �EXISTINCV PROPOSED OGS COMPONENTS AND LINES
O WELLS WITHIN 1 WFT WATER SUPPLY LINES DRNEWAYSI PARKING 13 SURFACE WATERS,STREAMS,RIVERS,ETC._
O DIRECTION OF SLOPE/CONTOURS O JJ
PERIMETER/CURTAIN DRAINS XJ NORTH ARROW .SCALE BAR
DIRECTOMS TO SITE AND SITE CC IXTONS:fax,I qj
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OFFICIAL USE ONLY BELOW THIS LINE
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OVGLUNTARY NTENANCERUMPING O BUILDING PERMIT OHOMESALE OCOMPIAINT OOTHER:
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SEWAGETMN MUSTMLISMOUNCER -LISTOFREGISTEREDSEWAGETANKS.TANKS MUSTMEET CURRENT MINIMUM SIZE REQUIREMENTS.EOUIFPED WITH RISERS
ANDLIDSTOSURFACE.MDIN MM1EWLUF FILTERWVPLICABLE). RECORD DRAMNGAND INSTALLATION REPORTREOUIRED FOR FINNLAPPROVA.
INSPECTOR SIGNATURE DATE APPUCATION EXPIRATION GATE APPUCATIONAPPROY 011INUE08Y DATE
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC WEW ON THE MASON COUNTY WEBSITE REVISED 1Z1120^9
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HEIGHT = 51" JUL 3 0 2014
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Masoh County OSS Installation Report pg. 2 Parcel n
ABANDONMENTRECORD
Were existing septic components abandoned as part of this project? - -------- ----— XYES ❑ NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-03O0? -------' YES ❑ No
RECORD DRAWING
Thin a p.....rawre.ad mu°t ea—un a and a.a dwne.rwuex b.lain.In txe nxtl N nalnl.nmce aullvleas and Ndn davalupreaM Typkai aemN
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❑ Record Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
1 certify that I installed the system in accordance with I certify that the system has been installed in actor- '
the septic design stamped"APPROVED"by Mason dance with the septic design stamped'APPROVED"by
County Public Health and that any deviations shown Mason County Public Health and that any deviations
here have been cleared/approved by both the designer shown here hem been cleared/approved by both
and Mason County Public Health and meet all Stale myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
1 further certify that all information contained on this I further certify that all information contained on this
form and attached Record Drawing Is accurate. farm and attached Record Drawing Is accurate.
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MASON COUNTY PUBLIC HEALTH -
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health:
Signature of Envimnmenfa! eatth Specialist Data (stamp,signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ONTHE MASON COUNTY WEB SITE d°°f1e°�tn010
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