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HomeMy WebLinkAboutBLD9124 Mobile Home - BLD Permit / Conditions - 12/1/1980 Adair, Ralph D. #9124 12-1-80 2 mi. down Little Egypt Rd. , back behind barn on left of road Rt. 10, Box 158 19-20-4 - N 330' of NE SE, E of R/W Mobile Home (Variance for blocks) �20j iA - 60000 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 DATE ISSUED PERMIT NO. OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE Ila/ / d7, o / he/1-on a 5 A 5U's-u 71-34 DIRECTIONS AD AA4z_X_ TO JOB SITE ' '4'• LEGAL :, (❑ SEE ATT HED SHEET) DESCR. 157 _ NAME MAIL ADDRESS tITY&STATE LICENSE NO. PHONE CONTRACTOR USE OF !`�'�'"L e— Z1Q—_ BUILDING Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: Y Valuation of work: $�� PLAN CHECK FEE PERMIT FEE z SPECIAL CONDITIONS: ' BEDROOMS {DECKS CARPORT [] NOTICE BATHROOMS (TOTAL SO. FT GARAGE L] SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT ❑ ATTACHED CJ OR AIR CONDITIONING. TOTAL SO. FT./7&0 FIREPLACEX DETACHED ❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR- CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER I certify that I am a currently registered contractor in WORK IS COMMENCED. the State of Washington and I the aware of the FOR OFFICE USE ONLY ordinance requirements regulating the work for which the permit is issued and all work done will be in conformance therewith. PERMANENT SHORELINES I SEASONAL Li FLOODPLAIN L i Firm E.D. NO. S.E.P.A. ❑ By Special Approvals IN OUT YES APPROVED NO Lie. No.— Date ZONING PLANNING DEPT. OWNERS AFFIDAVIT ALTH DEPT. PUBLIC WORKS I certify that I am exempt from the requirements of the FIRE MARSHAL contract or registration law RCW 18.27, and am aware of the Mason County ordinance requirements for BUILDING DEPT. which this permit is issued and that all work done will ROAD ACCESS a be in conformance therewith. n E O R VEHICLE E MIT N� �ner�- Date��"�o�7 e PPLI ATION A BY PLANS CHECK BY ABXEKISSU NCE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH PLOT PLAN ADDRESS A-- T /Lg, �� I( d 4L' ���QL4`'� PERMIT NO. o = a n s A OO LEGAL J DESCRIPTION LOT BLK ADDITION a SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft. ` INSTRUCTIONS TO APPLICANT 4 THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA- TION A^ID SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR- TION THEREOF. U` INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' r 1 I/We certify that the proposed construction will conform to the dimensicJns and uses shown above and that no changes will be made without first obtaining approval. �i_ \� •� �� .��� NAME(S) OF OWNER(S) OF SITE ! STRUCTURE(S) (PRINT) VRE F OWN ER(S) AUORIZ D RE NTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE /,k ,_ 7) LZ— .V i SHELTON PRINTING MASON COUNTY DEPARTMENT of GENERAL SUVIGES Courthouse Annex 2 N. Fourth & W. 'Ce Al dar JJ# , 4#J_* P.O. Box 186 Shelton, Washington 98584 Wil rd W. Wool f, M.D. (206) 426-5593 Director - Ken Stevens County Health Officer building environmental health maintenance parks&recreation planning sewer&water APPLICATION FOR REPORT ON INDIVIDUAL SEWAGE DISPOSAL SYSTEM AND/OR WATER SUPPLY It is the established practice of many lending institutions to obtain information from the local health department pertaining to the acceptability of the individual sewage disposal systems and/or water supplies. Q� DATE FEE 0 'RECEIPT # C� INFORMATION REQUESTED ON: v INDIVIDUAL SEWAGE SYSTEM WATER SUPPLY Located At: 10 i 5- Number Street,- / City -� Zip Directions to Property: � �� ,� ) --(' / X ii 1 -L'z^d L_7 4" r4 ,��/A��,J/.,,�, , /[t L-i1� �7V..:'-.�-�G l'�[. �i 7T�v ��irn� ��- ...) 'ht./��; rY�.-.:•>. /,.�./f'-:� ��i r.._ , t. -c `T.y G2` lie°/�. : r/ /�) � i`Legal ��-- Description:a o� P,�Z:r� , X 33o <� w e. :�,,, fo !Z. �74, i•7 QQt.Z�ht T .7 f LJ_ea 7� .�1��.. P,..;�i,CL1 6`�.f`h�P .F -:-1- l� 'f", .r.zc 4 -�:�P e��`�. .CQ.��.!.•i.,7icr�o Owner or Builder: )x,e Ybar Home Built: /9� Purchaser. -�'-,,l y �'�u,2tX , /1-1-2z/11 .� Send Report To: 17 Signature of Applicant:��Zc, • , c /f �!� , 7 Phone: 4/__�2 6�, The septic tank must be pumped and one end of the drainfield line exposed. A copy of the bill from the pumper must be sent to the health department, indicating size of tank (in gallons) , condition of tank and drainfield. Notify the health depart- ment as soon as tank is open and drainfield exposed for inspection. FOR HEALTH DEPARTMENT USE ONLY Date Received Date-Site Inspection ii-�-6 - o SEWAGE DISPOSAL SYSTEM Date-Final Inspection k _ House Occupied House Vacant X _ It is the opinion of this health department that this individual sewage system is functioning satisfactorily. Sewage was discharging on the surface of the ground. There are indications that this system may malfunction at times. There is indication of malfunction on nearby properties. Other: WATER SUPPLY: The supply does conform with drinking water standards of this department. The water supply does not conform as follows: Approved by: r -EltVIRONMENTAL HEALTH DI SIGN DSHS 13.173(Ri•81) STATE OF WASHINGTON 0 DEPARTMENT OF SOCIAL AND HEALTH SERVICESO WATER BACTERIOLOGICAL ANALYSIS SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COPY . If instructions are not followed, sample will be rejected. i_. DATE COLLECTED TIME COLLECTED COUNTY NAME MONTH DAY YEAR 0 f TYPE OF SYSTEM 'IF PUBLIC SYSTEM,COMPLETE; ❑ PUBLIC LD. NO. CIRCLE CLASS INDIVIDUAL 1 2 3 4 (serves only 1 residence) NAME OF SYSTEM SPECIFIC LOCATION WHERE SAMPLE COLLECTED SYSTEM OWNER/MGR.NAME AND T EPHONE NO. lie.kitchen tap a school,fire station.fountain) < , i f- �. SAMPLE COLLECTED BY:(Name) SOURCE TYPE . ' - . ❑ SURFACE VWE' ❑ SPRING ❑ PURCHASED ❑ COMBINATION z or OTHER SEND PORT TO:(Print Full,Name,Address and Zip Code) I,- l3�iEG1Cla'L ; W_DtSFtiIVGTON TYPE OFSAMPL check only o is column) 1 RFNKINCaWATER ❑ Chloinated(ResiSWal:—Total—Free) check treatnren3— ❑ Filtered V •.UntreaM�d or Other 2. ❑ RAW SOURCE WATPR 3. ❑ NEW CONSTRUCTION or REPAIRS 4. ❑ OTHER(Specify) COMPLETE IF THIS SAMPLE IS A CHECK SAMPLE PREVIOUS LAB NO. 1 PREVIOUS SAMPLE COLLECTION DATE REMARKS: ,.t LABORATORY RltSULTS(FOR LAB USE ONLY) MPN.COLIFORM STD PLATE COUNT SAMPLE NOT TESTED BECAUSE: /5 tubes posilve /i711 MPN DILUTION THST UNSUITABLE. ❑ Sample Too Old ❑ Confluent Growth - ClNot in Proper Container MF COLIFORM. 2. <E..T.ss NTC ElInsufficient Information /100 ml Provided—Please ReadInstructions on Form FECAL COLlFORIvi3. Debris ❑ MPN "❑ MF 4El 100 in1 FOR DRINKING WATER SAMPLES ONLY,THESE RESULTS ARE: ❑,'.4ATISFACTORY ❑ UNSATISFACTORY' SEE REVERSESIDE OF GREEN COPY FOR EXPQANATION OF RESULTS LAB N0. DATE;TIME RECEIV� ' RECEIVED BY DATE REPORTED A OR TORY: � t - I REMARKS CLW('fit"= . rw. SITE '�l. //,�y-- , I --/- A M ON COUNTY HEALTH DEPARTMENT ' FOR DEPARTMEV_7 .USw ONLY ENVIRONMENTAL HEALTH SECTION DATE BASIS FOR FEE AMOUNT RECEIPT 428 WEST BIRCH STREET • SHELTON, WA. 98584 NUMBER PHONE (206) 426-5561 APPLICANT SIGNATUR Ila 00 �C8 7 0 ADbRESK PHONE /INOT �a6-9i 2b SITE: APPROVED ❑ APPROVED 'PROPERTY OWNER BY: ADDRES PHONE DESIGNED SYSTE REQUIRED S A E F �._,..,_' SEWAGE CONTRACTOR 1 SEWAGE: APP OV D ❑ NOT J D G , (� APPROVED LEGAL DESCRIPTION / BY: 1� I' SOIL TYPE / I Q TY OF '' // NO. OF LOT All BUILDING `!?tJ7�C�_ _BEDROOMS SIZE DEPTH TO WATER TABLE PERC. RATE SINGLE RESIDENCE icy PUBLIC WATER ❑WATER SYSTEM SYSTEM NAME SEPTIC TANK( )S GAL. PUMP REQ. `!74 COMMERCIAL ONLY LIQUID WASTE G.P.D. DISTRIBUTION TILE TO'4A, FEET DIRECTIONS TO SITE: FILTRATION AREA SQ. FEET QUANTITY OF APPROVED STONE--CU. YD. AND-CU. YD. FILL REQUIRED CU. YDS. FINAL INSPECTION REQUIRED BEFORE BACKFILLING DEPTH OF BACKFILL 2"STRAW OR PAPER STONE OVER TILE ' PIPE SIZE STONE SITE PLAN AND SPECIAL STIPULATIONS I 0 I UNDER TILE At (INDICATE DIRECTION OF DRAINAGE) CROSS SECTION OF TRENCH moo CN •� nod, ��� Y COMMENTS: THIS SITE PERMIT EXPIRES rMcZ VED ASO'' C0'J 'TY �IEALT{l 'EPA!�T:,E` T N O V 2 4 1980 E-VI7'0'`° TAL HEALT'' SECTIO" MAZGN COUNTY HEALTH DEPARTMENT 428 `:'est Birch Phone: 421-5551 Shelton, ',:ashin;ton 93584 On-Site Sewage :'isposal Syster:. besign Site Inspection ,o. 16"74- ate Submitted 11-.24 -mod Tax Parcel .!o. Is Treatment Proposed? Attach Legal Description ( ason County T Yes 'o only` If yes, attach 1pecifications and ,ana�enent Agireement. For i� -4 A dres� . Zip Engineer or :,esi ner I. SOIL LOG LATA: dl P2 1;3 :S`4 0 - /2" fir/ 1 Ad-/L S' -r- /2 — -1 Z /1 Q, ; GCS 50IL TYPE S�RSO" . e th to seasonal hi htater L 9 Depth to ii^p ernieable layer :epth to mottling II. PE::COLATIO:' TESTS if uepth Time ,epth :.epth Time Stabilize('. '.ate Stabilized Rate Stabilizes: .ate On-Site Ser,age Disposal System f.esil-n Pa^e 2 III. CALCUILATIWS �\ A. "o. of be.roo-is 3 Estimates' GPi, If other than house, show calculations to -Determine GPO: Application "ate: (from percolation tasts an:: PIGS Publication 52 or state 2ui:ielines: C. grainfield Sizing: 1. Absorption area square feet Bottom L71 Sidewall 2. `!olume c>2jo cubic yards 3. Total Length Punp F,equirements: 1. Is hinh level alarm provi. e_`? 2. Elevation difference feet 3. Gallons per Canute , jischarre volume 4. Horsepo.:er of pump 5. Volurie of sump E. Tank _.._ If ea•:Iy ma::e rive manufacturer an:� size If custom built, attach draelin and specifications :ith the followinj informa-cion. 1. Overall dimensions, capacity in gallons 2. 411 material and thickness 3. i-lur:ber of compartments an: dimensions of each 4. Distince of inlet, outlet, anel baffle openings from top 5. Location of access openin-,,,s On-Site Serfage �-isposal System resign Pace 3 C"OSS SEC T IO'", OF TYPICAL i JtE:'CH Surface A. ',!igth of Trench ' feet • enth ?rom drainpipe to trench bottom ,_feet { C C. Total Depth of tr;nch feet Ce.th from trench bottom to har�.�p n o seasonal high s:,ater feet. Seasonal high dater or har ,pan D. J^A';.'I::;' CF SYS"E,' Shoc:! the follo ,ink items on attache:! sheet: A. 1-orizontal syster, plan aw!, if mount; system is proposed or slopes exceer 15''. ;.:-ovi cross sec tior.. S. Scale C. �enchnar:c Q , stubout elevation, tank outlet elevation, (botton of pipe), elevation at finish grace at center of rainfielc;. Property lines, building, trees, slopes in excess of 5`., driveway. E. All hells or drinkinry .,jater supplies :zithin 125 feet, t.ater lines. F. :Tainare systen detail (i.e. curtain 'rain). f'. 'replacement area. On-Site Sel.�wie uisposal System. [Jesign Page It Date Site .`o. Legal escription I, � A� —agree not to holy; the health %eparWent responsible in the event that the special system as proposes: by falls to operate as require:. by Articles VI an a VII, of the .*ason County Health r::epartr,ent Comae. Signature Subscribe,' an,-: s Torn before me this /Pk; ay of :'ovary Qublic fo the tate of ';'ashinrton resiuinry at ✓ - )�a-�L�o i i I 1 j i i I I I17 1 i SITE NO. PARCEL NO. • THURSTON-MASON HEALTH DISTRICT r�aTE BASIS FOR FEE ti AMQUNT NUMRECEBER DIVISION OF'ENVIRONMENTAL HEALTH - 7� ��c o /O0 p 529 WEST FOURTH 110 W.K ST P.O.BOX 746 7 / PHONE 753-8073 PHONE 426-4407 OLYMPIA, WA 98501 SHELTON, WA 98584 OWNER r P.O. PHO DIRECTIONS TO SITE: TOTAL FEES '5 �r,�l� de��nt ,C;�f��/e zy �a�' ) c,3a, SEWAGE 1 �� YJ�7�.• d'►lJ CONTRACTOR �� V ,/l e• ADDRESSOR y,apQ !P- � LOCATION Oa NAME OF PLAT Nloe) /Y / SOIL TYPE ` TOWNSH RANGE SEC. DEPTH TO WATER TABLE FT. WATER ❑PUBLIC PRIVATE SOURCE PERC. TESTS: INCHES PER HOUR TYPE OFF LOT BY: DATE ,r BUILDING BASEMENT y�s SIza NO.OF NO.OF �/ / GARBAGE PRIMARY GAL.C4 SECONDARY BEDROOMS BATHS DISPOSAL SEPTIC TANK ISI AERATION GAL. SPACE RESERVED FOR DISTRIBUTION TILE TOTAL FEET REPLACEMENTS DISTRIBUTION FIELD SQ FT. NORTH - SITE PLAN AND SPECIAL F,TIPULATIONS: TRENCH BOTTOM AREA 6(-0'6SQ. FEET /V s lo?7f 30h / QUANTITY OF w ' Ipwelf P.ark n/.- 330 APPROVED STONE CU. YD. SAND CU. YD. half gyp,�I• !� FILL REQUIRED CU. YDS. Ale It) Y THE ELEVATION OF THE BUILDING SEWER SHALL BE SUCH THAT \� THE MAXIMUM DEPTH OF THE DISTRIBUTION TILE SHALL BE BE- TWEEN 12 INCHES AND 36 INCHES FROM FINISHED GRADE TO LU TOP OF TILE UNLESS OTHERWISE STIPULATED BY THE HEALTH OFFICER. IF THE ELEVATION OF THE BUILDING SEWER IS TOO LOW TO MEET THESE ELEVATIONS,A SEWAGE EJECTOR MAY BE REQUIRED. L ISOLATION STANDARDS FOR PRIVATE WATER SUPPLIES: BETWEEN WELL AND TANK OR ANY PART OF THE TILE FIELD, 100 FEET FOR SINGLE RESIDENCE, MOBILE HOMES, DUPLEXES AND MULTIPLE DWELLINGS. NO DRAINFIELD WITHIN 100 FEET OF ANY WELL, FRESH WATER LAKE OR STREAM)00 FEET FROM ANY SALT WATER BODY. NOTE: "FOOTING DRAINAGE, DOWNSPOUTS, WATER SOFTENER AND ANY OTHER WASTE WATER NOT DEFINED AS SEWAGE SHALL NOT BE CONNECTED TO OR DISCHARGED INTO THE SEPTIC TANK SYSTEM OR THE SEWAGE DISPOSAL AREA". ALL SEWAGE, INCLUDING SINK AND LAUNDRY WASTE, MUST BE CONNECTED TO THE SEPTIC TANK. FINAL INSPECTION REQUIRED BEFORE BACKFILLING OFFICE USE ONLY TO BE BACKFILLED AFTER INSPECTION DATE APPLICANT MUST CALL FOR INSPECTIONS LISTED BELOW � 12' TO El— SITE: APPROVED ❑ APOPROVED �i 2" STRAW BY: C' I �� '� STONE NOT 7 O OVER TILE SEWAGE: ❑ APPROVED ❑ APPROVED 1/ r BY, F STONE NOT UNDER TILE WATER: Cl APPROVED ❑APPROVED BY. I E - 1\ CROSS SECTION OF TRENCH ©r MASON COUNTY HEALTH DEPARTMENT `` 428 WEST BIRCH "TREET ' SHELTON, WASHIN?ON 98584 v PHONE (20b)'426-1561 Y (Jwc'll G AKrt1ENT RECORD OF FINAL INSPECTION OF YOUR SEWAGE DISPOSAL SYSTLj'M OWNER ADDRESS O �. THIS RECORD IS NOT A A ANTE OF PERFORMANCE. LEGAL A SEPTIC SYSTEM IS NOT A MUNICIPAL SEWER. HOWEVER DESCRIPTION _ -y WITH PROPER MAINTENANCE AND CAREFUL USE OF 42 WATER IT CAN GIVE MANY YEARS OF TROUBLE FREE SER- VICE. MANY PROBLEMS WITH SEPTIC TANKS ARE CAUSED SOIL BY FLUSHING EXCESSIVE AMOUNTS OF PAPER, CLOTH COMMENTS�"' AND PLASTIC MATERIALS DOWN THE DRAIN, OR BY SITE FIELD LARGE AMOUNTS OF WATER FROM LEAKY FAUCETS OR NO. I SIZE JQ X gJ; FAULTY FIXTURES. DEPTH TO MONTH THE SEPTIC TANK ITSELF SHOULD BE CLEANED EVERY WATER TABLE OF YEAR TWO OR THREE YEARS DEPENDING ON THE HABITS OF THE INSTALLER FAMILY, THE NUMBER OF FIXTURES IN THE HOUSE, AND THE AMOUNT THAT A GARBAGE DISPOSAL IS USED. CLEAN- SIZE ING AT THE RIGHT TIME WILL AVOID THE RISK OF INJUR- SEPTIC TANK (S) ! 2� ING OR DESTROYING THE DRAINFIELD DUE TO SOLIDS DRAINFIELD FEET CARRYING OVER INTO THE DRAINFIELD. CALL THE LENGTH Q MASON COUNTY HEALTH DEPARTMENT FOR A LIST OF TRENCH AREA SQ. FT. LICENSED SEPTIC TANK CLEANERS IN YOUR AREA. THE TILE CLEANER CAN SERVE YOU BEST IF YOU SHOW HIM THIS DEPTH to CORRUGATED RIGID ❑ CEMENT RECORD WHEN HE COMES. DEPTH HEAVY TRUCKS OR EQUIPMENT SHOULD NEVER BE ROCK �� BELOW CU. YDS. PIPE DEPTH TOTAL q� � f� DRIVEN OVER THE TANK OR DRAINFIELD. CONSULT THIS SPACE RESERVED FOR RECORD IN CASE OF ANY BUILDINGS, DRIVEWAYS, REPLACEMENT DISTRIBUTION FIELD: SQ. FT. SWIMMING POOLS, OR EXTENSIVE GRADING OR FILLING ARE LATER CONTEMPLATED. NORTH ` SHRUBS OR TREES SHOULD NOT BE PLANTED CLOSE TO THE SEPTIC TANK AS THEY WOULD INTERFERE WITH CLEANING OF THE TANK. THEY CAN BE PLANTED IN THE DRAINFIELD AREA PROVIDING WILLOWS ARE NOT USED. THE YARD GRADE IN THE DISPOSAL AREA SHOULD BE SUCH THAT SURFACE WATER IS NOT POCKETED ON THE d DRAINFIELD. ANY SETTLING OF THE GROUND OVER THE B TRENCHES SHOULD BE FILLED IN WITH SOIL. DO NOT EX- CESSIVELY WATER THE LAWN IN THE DRAINFIELD AREA. WATER EVAPORATION FROM THE DRAINFIELD IS ABOUT ITS — WATER TO ONE HALF INCH OF RAIN PER DAY. T FOOTING DRAINAGE, DOWNSPOUTS AND WATER ?S' SOFTENER RECHARGE WATER SHOULD NOT BE CON- NECTED TO THE SEPTIC SYSTEM OR DISCHARGED INTO THE �ARK�NSJ DRAINFIELD AREA. THE TYPES OF BACTERIA NEEDED IN A SEPTIC TANK ARE ALWAYS FOUND IN SEWAGE. THERE IS NO NEED TO ADD YEAST OR OTHER STARTERS TO A SYSTEM. THE USE OF RE- JUVENATORS OR CHEMICALS TO CLEAN A SEPTIC TANK HAVE NOT BEEN PROVEN TO BE BENEFICIAL AND MAY BE "T HARMFUL BY FLUSHING SOLIDS OUT OF THE TANK OR BY /2cc.lL CHANGING THE CHARACTERISTICS OF THE SOIL. THE NORMAL USE OF BOWL CLEANERS OR CLEANING COM- POUNDS WILL NOT KILL THE BACTERIAL ACTION OR SLOW SOUTH DOWN THE OPERATION OF THE SEPTIC TANK. ' THIS IS AN IMPORTANT DOCUMENT DATE APPROVED BY KEEP IT WITH DEED OR OTHER - 3 ESSENTIAL PAPERS. DATE CERTIfi4D BY