HomeMy WebLinkAboutSWG2024-00249 - SWG Application / Design - 6/4/2024 584
MASON COUNTY 415N 6 SHELTON,
HELTON,SHELTO70,EXT 400
SH STREET
36 SHELTON,
V EFT 400
BELFAIR:360-2764467,EXT 400
Public Health & Human Services ELMA 360-092-5e139.EXT 400
4 FAX 360-427-7787
On-Site Sewage System Tank Only Permit: SWG2024-00249
OWNER KIM YONG KOO Phone:
Address. 7480 W SHELTON-MATLOCK RD SHELTON, WA 98584
APPLICANT KIM YONG KOO Phone:
Address: 7480 W SHELTON-MATLOCK RD SHELTON,WA 98584
SEPTIC INSTALLER BRAYDEN SCHOENING• Phone: 360-742-2982
Address: 121 W GRIZDALE DRIVE SHELTON,WA 98584
Site Address: 7480 W SHELTON MATLOCK RD
Primary Parcel Number. 420181290040
Permit Description: Tank replacement permit-Repair with 26ft+to surface water
Permit Submitted Date: 06/0412024
Permit Issued Date: 06/06/2024
Issued By: Rhonda Thompson
Current Permit Fees Paid: $266.00 (addldanal fees mar ee,ecmred oron instaiauon or syamm).
Permit Expiration Date: 06/05/2026 (baud on date or msrectoal
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Private Well/Spring
Additional Details: Septic tank
Permit Conditions:
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained
1 Horizontal setbacks per WA C246-272A-02 10 must be maintained, unless prior approval is
obtained
4 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
3 Mason County Asbuilt form, Record Drawing, and Installation fee must be submitted for
final installation approval.
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 ANDIOR DESIGN
APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.gov/health/environmental/onsite/ms-inspection-request.php or call:
360-427-9670,extension 400.
415 N 6TH STREET,SHELTON,WA 98584
MASON COUNTY SHELTON 36D+75.0167,EXT 480
BELTON:360 2 7-9467,EXT 4DO
Public Health & Human Services ELMA:36(PI82-SM,EXT 40a
4 FAX:36a 27-7787
5 Must meet mitigation to reduce tank setback to surface water to 25h.
1)Extra protection of integrity of tank and joints fa) Waterproof surface barrier applied to
concrete tank consistent with Manual of Concrete Practice ACI 515.1R. Flexible rubber
boots or compression seals meeting ASTM C 1644, or flexible couplings meeting ASTM C
1173 used for inlet and outlet connections to provide flexibility in case of tank settlement
while still maintaining a watertight seal. An approved double-wall fiberglass tank may be
used in lieu Die concrete tank. 2)Performance testing of tank 2a)Concrete tank tested
for water-tightness consistent with ASTM C 1227. Fiberglass tank tested for water-
tightness consistent with JAPMOIANSI Z7000-2007. 3)Accessibility of tank for ease of
operation and maintenance 3a)Access openings at or above finished grade with lockable
lids or secured to prevent
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: mmoncountym.gov/health/environmental/onsiteloss-inspection-requ"t.php or call:
360427-9670, extension 400.
OFFICIAL USE ONLY
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APPROVED
JUN 06 20A
MASON COUNTY ENVIRONMENTAL HEALTH
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MCPH RECORD DRAWING (ASBUILT) Pg.
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If the designer or installer feel the need for soditional in...... ioNoomments, it may be attached No.Pages Attached
Record drawing may also be on a separate Page attached.
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER
/cam' that the system has been installed in accor-
1 cre:that/installed the system in accordance with N
fhe septic design stamped'APPROVED'by Mason dance with the septic design stamped'APPROVED'by
County Public Health and that any davietions shown Mason County Public Health and that any deviations
here have been Gearedfapproved by both the designer shown here have been cieared/appmved by bath
and Mason County Public Health and meet all State myseff and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on thus I further cedity that as Information containedW this
formpgd attached R� Drawing is accurate. form and attached Record Drewing is accurate.
Signal re in ale, Date
Printed Name of Slgnee .W4+'L 9 r �QPa7r
m
MASON COUNTY PUBLIC HEALTH
The undersigned appmves this Installation Report and
wing on behalf of Mason County Public RE i WAi RIC
D I NER'
Health:
- >PIpP S�v.59'IY
ure of Environmental Health Specialist Date (das7 ss stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON CWNTYWEB SITE WEmdir 212014