HomeMy WebLinkAboutSWG2025-00158 - SWG Application / Design - 4/30/2025 415 N 8TH STREET,SHELTON,WA 98584
J L MASON COUNTY SHELTON:360427-9870,EXT 400
BELFAIR:360-275.4467,EXT 400
482-5289,EXT 400
Public Health & Human Services ELMA:360.FAX:380-427-7787
On-Site Sewage System Tank Only Permit: SWG2025-00158
APPLICANT CAPPELLUTI TRUST Phone:
Address: PO BOX 1488 HOODSPORT, WA 98548
OWNER CAPPELLUTI TRUST Phone:
Address: PO BOX 1488 HOODSPORT,WA 98548
APPLICANT DENNISE PETRUCCI Phone:
Address: 445 WISHON WAY W MADERA, CA 93636
SEPTIC INSTALLER DARIN OGG* Phone: 360-790-3021
Address: PO BOX 1336 HOODSPORT,WA 98548
Site Address: 51 N OLD MILL HILL RD
Primary Parcel Number: 422125121008
Permit Description: Replace septic tank
Permit Submitted Date: 04/29/2025
Permit Issued Date: 04/30/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $270.00 (additional fees may bo requked upon Installation of system).
Permit Expiration Date:
04/29/2028 (based on data of inspection) _
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: Public Water System
Additional Details: IM-1080
Permit Conditions:
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
1 Horizontal setbacks per WAC246-272A-0210 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.
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/environmentallonsiteloss-inspection-request.php or call:
360-427-9670,extension 400.
1
— — OFFICIAL USE ONLY ---- - - --
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MASON COUNTY
COMMUNITY SERVICES �� i"""� o Mtn
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ON-SITE SEWAGE TANK ONLY APPLICATION
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APPLICANT PHONE
Telnvt(,le AA/UCc i (I°dA0 559 - -7a ,r5o2o c
MAILING ADDRESS-STREET,CITY,STATE.ZIP CODE 3
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14 S UJ (sCLav, iNt- w. Miaerq , Co , 93G m
SITE ADDRESS-STREET,CITY,ZIP CODE
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NAME OF DESIGNER PHONE I
, 2 PHONEoygIj / I 360 79O ,oZ (
TYPE OF WORK(am a one) DRINKING WATER SOURCE
❑NEW CONSTRUCTION/UPGRADES SttIEPAIR/REPLACEMENT O PRIVATE INDIVIDUAL WELL ❑ PP IVATE TWO- A/ LL I�
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COMPONENT(S)TO BE REPLACED/ACED/INSTALLED ,PUBLIC WATER SYSTEM / v /7 UO , I 01- i
-pStPTICTANK 0 PUMPTANK ❑RV HOLDINCi7ANK eEOROOM3 LOT SIZE
❑OTHER w
OTHER DETAILS(Wed e1 rivet&Poly) TANK(S)SETBACK CHECKLIST v r �-
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O SURFACING SEWAGE (EXISTING FAILURE 0 SHORELINE IOOFT+PUBLIC/COMMUNITY WELLS I
SUBMITTALS -SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS 1
❑PLOT PLAN(REQUIRED) ❑TANK CROSS SECTION(REQUIRED) pp 10FT4-DRINKING WATER SUPPLY LINES IIII I
O PUMP DETAILS(IF APPLICABLE) O WAIVER(S)(IF APPLICABLE) Oi+,SET+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST O I O
i PROPERTY LINES AND EASEMENTS II EXISTING/PROPOSED STRUCTURES If EXISTING/PROPOSED OSS COMPONENTS AND LINES
2'WELLS WITHIN 100FT {'j.WATER SUPPLY LINES ❑DRIVEWAYS/PARKING $SURFACE WATERS,STREAMS,RIVERS,ETC... I O
a DIRECTION OF SLOPE/CONTOURS 'PERIMETEFU CURTAIN DRAINS in NORTH ARROW f.SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS(eX NOW 9a) 021 0`p N.(( l - Nt { LL go( t S Or, vu2_
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- - - - OFFICIAL USE ONLY BELOW THIS LINE -- - A 0 2
AP J zo25
UPGRADE I FAILURE SOURCE(for npo t ig purposes) •
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ['OTHER. gl/_
CMM OENTS I COIAIT)ONS ..1
04)Vjt,Ce kkQ 461 n1L-
SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS'.TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED WRH RISERS
AND LIDS TO SURFACE,AND INCLUOEAN EFFLUENT FILTER(IF APPLICABLE).RECORD DRAWING AND INSTALL AI1ON REPORT REQUIRED FOR FINAL APPROVAL
INSPECTOR SIGNATURE DATE APPLICATION RATION DATE APPLICATION APPROVED/ISSUED BY DATE
e"--- q 0 1--e 6 CI/34-M--
THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 11R/2015
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APPROVED
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APR 30 2025
MASON COUNT ENV1RONMENTAL HEALTH
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IM-1060 General Specifications and Illustrations
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The IM-1060 is an injection molded two piece mid-seam
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plastic tank.The IM-1060 injection molded plastic design L I Oki 1 I�A
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for accepting an engineered EPDM gasket. Infiltrator's ';-v °o t:a o ' ,_1 1 , e
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to deliver proven means of maintaining a watertight seat. '. °,, l a l f 1. `�i
The two-piece design is permanently fastened using a v..=4lta�t''t ! ! l ��"' '"��
series of non-corrosive plastic alignment dowels and ���� �i''r.'JI A 1. 1 1_ 1tAill�
locking seam clips.The IM-1060 Is assembled and sold —
through a network of certified Infiltrator distributors. It70 PIApr owntfNLTH
VIEW
Must be backfilied and installed in accordance with TOP
Infiltrator Water Technologies,infiltrator IM-Serles Septic OUTLET
Tank General installation Instructions and for shallow �.
ground water conditions reference the Infiltrator IM-
Series Tank Buoyancy Control Guidance. .r�P - -{111- - �II', I
Please visit www.inflitratonvater.com/Images/pdf/ a �r=f-_-^-+.4ij-. nOA
ManualsGuides/TANK01.pdf for the latest information. ,wx kill���' ��� ly
MOLT
lf.1-1060 tFrerGmen
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Worldng Capacity 1094 gal(4141 L)
Total Capacity 1287 gal(4872 L) END VIEW
Airspace 16.5%
Length 127'(3228 mm) PKc o e R A 4 u ozllf 614(6t0,ACCESS OPENINGS KITH LoOQ$G LDS Ea
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Width 62.2"(1580 mm) •aETnk
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Length-to-Width Ratio 2.3 to 1 1 y.cT r i T
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Height 54.7"(1389 mm) �a L p'°hi !�E—i
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Liquid Level 44"(1118 mm) 44.0 I--
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invert Drop 3"(76 mm) cSUPPORT p`EP;H
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Fiberglass Supports 2 wAuwaaAr
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Compartments 1 or 2 _
Maximum Burial Depth 48"(1219 mm) SIDE VIEW
Minimum Burial Depth 6"(152 mm)
Maximum Pipe Diameter 6"(152 mm)
TANK TOP CONTINUOUS
Weight 320 IGs(145 kg) HALFGASKET
INTERfOti •+41 SEAM CLIP
APR 30 2025 Pm
ALIGNMENT
MASON COUNTY Ei�`,gRONMENf�R"ff ALTH TANK BOTTOM
4 Business Perk Rood R E T HALF
PA.Box MS
OW Saybrook CT 96476
i N F I LT R AT O R' moon,-4438
677-T000-Fax "-7001 MID-HEIGHT SEAM SECTION
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water technologies www,affttrator8Watsrcom
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REA&Is a trademark of Pdy4ok,Inc.TUF-TRE is a ragbtered trademark of 1UF-TnE.1NC.Ultra-Poo Is a traddrnrk of IPE7f kw.
O 2016 trdlrafor Wafer Technologies,u.c.Al rl¢rts reserved.Painted In USA
1M42 1116
Contact infiltrator Water Technologies' Technical Services Department for assistance at 1-800-221-4436