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HomeMy WebLinkAboutSWG2019-00198 - SWG Inactive - 6/3/2019 - 415 N 6TH STREET,SHELTON,WA 99584 BE MASON COUNTY $HELFAIR 360427-9670.EXT 400 COMMUNITY SERVICES ELMA.360-275-0467,EXT 400 LMA:360482-5269,EXT 400 aamori..�naE.nmmwxx.xnta....��na�an FAX:U0427-7767 ENVIRONMENTAL HEALTH REVIEW OF OSS APPLICATION ROBERT PAYSEE- Pioneer Digging Inc E 3083 MASON BENSON ROAD GRAPEVIEW, WA 98546 Applicant: LETTUCE LOAF,LLC Parcel Owner: LETTUCE LOAF, LLC Site Address: 9451 NE North Shore Rd Primary Parcel Number: 322245101010 055 Permit Number: SWG2019-DO198 Permit Description: Tank only replacement Permit Submitted Date: 06/03/2019 Permit Review Date: 0 7/3 112 01 9 The above mentioned Onsite Sewage System Application was reviewed by Environmental Health and found more information is required. Unable to approve replacement tank in county road easement. If you have questions or concems let us know. Sincerely, � w k Jeff Wllmoth 360.4279670 EXt.543 jwilmoth@co.mason.wa.us �/ r "ISO 7 $4 Av+ U� OFFICIAL USE ONLY MASON COUNTY PUBLIC$EALTA AUS.N B ONSITE SEWAGE SYSTEM APPLICATION M — E Mrt0 o m 415N6thStree4(Btd9S) ShekonWA98S84 < U7 Shekon:360-477-967DW400 B40r..3 2754467eM40 .JPYV C,� G _ y 0 O A Z N Z D APPl1G4M P1gNE D A LETTUCE LOAF LLC m m 1— "UNOILORFSS-STREET.GTY STATE,➢PCOCE 3205 - 63RD AVE NW GIG HARBOR WA 98335 ic SITEPDDRESS-STREETGTY 9PCDDE m 9541 NE NORTH SHORE ROAD BELFAIR WA 98528 z NAME OF DESIGNER PHONE I W ROBERT H. PAYSSE 360-426-1803 NAME OF INSTALLER PHONE N CXECKrLLLAPRIGBLE nEM3 ORIWRN['W4TEfl SOIINCE O IN D NEWCONSTRUCYION 0 RVHOLDINGTANKONLY D PRWATEINDMOUALWELL W IN 0 REPLACEMENT SYSTEM D INSTALIATIONPERMITONLY D PRIVATETWOIPARTYWELL 2 0 TABLE 9 REPAIR It SINGLE FAMILY D COMMUNITY/PUBUCWATER SYSTEM I A d TANK(SI ONLY D COMMERCIAL SYSTEM NAME: ❑ UPGRADE TO EXISTING ❑ OTNER: BF1N10CM3 LOT SIZE D EXISTING FAILURE �Mi1 R.a 0.83 O INFECTIONS TO MTE.�SPECIFlCPNDADNSE Of ANY NEEDED INFORMATION FORACCE55(u trlslWM1 � lO FROM BELFAIR: OUT NORTH SHORE ROAD TO SITE ADDRESS ON LEFT. 0 lO -4 O ' SITEMUSTBEFLIGGED FRPMMAINROm AAD IFSTMOLF9 MOST BE FIADGED NTTM MTNOtFMY1BERd 10 OFFICIAL USE ONLY BELOW THIS LINE UPCi4LE/FAI W RE SOURCE Ru RFOIIYq pu(C W) DVOLUNTARY DMAINTENANCE/PUMPING DBUILDINGPERMIT E3HOMESALE DiRmP DOWER: INSPECT ASGLLEGS M EMS/CONGTICNS N(� SOILC ES: V•VERY G=GRAVELLY S=SMID L=LOAM M=SILT C=GAY E=EXTREMELY R=ROOTS INSPECTOR SMATURE DATE APPLICATION EXPIRATION DATE AFNfATNN1 AFFAOI£D BY L., THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON WE MASON COUNTY ABSORB REVISED 1272015 \ PUMP OUT AND ABANDON \ \ EXISTING TANK. CONNECT \ NEW SEPTIC TANK TO HOME \ \ AND EXISTING DKAINFIELD. \ \ SEPTIC TANK 15 TO BE COATED, WATER-TIGHT \ ` FI , TESTED FOR LEAKS, AND ND TR Tk AFFIC RATED. i Y / EDGE OF PAVEMENT �\ ULKHEAD AT EX ISTINGHOME PQQ�*- V9 PROPOSED Q� SEPTIC TANK EXISTING FAILED TANK \ w"" �' BULKHEAD \ exrwe \ \ THIS IS NOT SURVEY. \ /-/OOP CA IVAZ \ RELATIONSHIPS TO PROPERTY \ LINE5ARE ESTIMATES BASED \ \ ON EXISTING LANDMARKS, \ FIELI) MEASUREMENT5, AND \ GIS MAPS. \ INSTALLATION DESIGNER SIGNOFF/A5BMLT FEE WRL BE CHARGED AT TIME OF INSTALLATION CUSTOMER: LETTUCE LOAF LLC SCALE,I:W PIONEER DIGGING, INC PARCEL#.322245101010 SEPTIC DESIGNS ADDRE 9451 NORTH SHORE RD 3093 E.MASON BENSON RD, GRAN EW,WA98546 DESIGNER ROBEAT PAYSSE OFFICE-36"i t803 FAX-36oan-z353 DESIGN PAGE �OF_ _ m j \0 =r ` «$ \ƒ7714- of t f 6 -- `� w _ It 2 _ � : \ / d a t � \ zr 5 � ƒ � $§ \ � � \ } � � � f } ( — , �3 PAn ? ©§as