HomeMy WebLinkAboutSWG2025-00192 - SWG Application / Design - 5/21/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670, EXT 400
rn,
BELFAIR:360-275-4467, EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2025-00192
OWNER FISHER ROYCE & LIZA Phone: 1.360.463.2852
Address: 17010 E State Route 106 BELFAIR, WA 98528
APPLICANT FISHER ROYCE & LIZA Phone: 1.360.463.2852
Address: 17010 E State Route 106 BELFAIR, WA 98528
APPLICANT Kitsap Septic Pumping Phone: 3608715258
Address: P.O. Box 809 Manchester, WA 98353
Site Address: 17010 E STATE ROUTE 106
Primary Parcel Number: 222115000008
Permit Description: New 2-bedroom SFR septic tank to connect to the existing 3-
bedroom septic system shared with the existing 1-bedroom ADU
Permit Submitted Date: 05/21/2025
Permit Issued Date: 05/30/2025
Issued By: David Anderson
Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/21/2026 (based on date of inspection)
Type of Work OSS New Construction
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? No
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Public Water System
Additional Details: Hagerman concrete 1000 gal
Permit Conditions:
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
4 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
I
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND/OR DESIGN
APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.gov/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
DATE RECEIVED:
MASON COUNTY .a.. I. - "D-O a5
047.7, COMMUNITY SERVICES AMOUNT RECEIVED o M
Public Health(Community Health/Environmental Health) ^4 ' C
360-427-9670,ext.400 W 360-275-4467.ext.400 �t
415 N.6th Street-Salton,WA 98564 S\ V G ca 3 0 5 03 v� • t Z m
ON-SITE SEWAGE TANK ONLY APPLICATION
m• n
APPLICANT PHONE m
r
K,r-sa? Sc o, (-- .$mimykt kw... 6(=.-cacl-t-52S 8 Z
c
MAILING ADDRESS-STREET.CITY,STATE.ZIP CODE g
CO
?r O f,3ox $09 mAnckc.s#r 'W A 965 5 m
xi
SITE ADDRESS-STREET,CITY.ZIP CODE
I l o l o a Vrah-c- Q04.1 c,. t 6‘)
NAME OF DESIGNER PHONE
NAME OF INSTALLER PHONE v
"Oiss r en Miff,( "SC.d-.EVI-\--$25S, R /..TYPE OF WORK(select one) DRINKING WATER SOURCE O
0 NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL
`❑ PPRIIVATEE TWO-PARTY WELL Z
rs
COMPONENT(S)TO BE REPLACED/INSTALLED lil PUBLIC WATER SYSTEM S%i ,5 e I i ('t
SEPTIC TANK ❑ PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE �n FT
I\11
❑ OTHER 2. 261, 00o Sty. r 1- co �_-_111
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r
O I
0 SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINE III 100FT+PUBLIC!COMMUNITY WELLS n
4
SUBMITTALS la 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
til PLOT PLAN(REQUIRED) 0-TANK CROSS SECTION(REQUIRED) SD 10FT+DRINKING WATER SUPPLY LINES IC '
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST r I O
® PROPERTY LINES AND EASEMENTS $.EXISTING/PROPOSED STRUCTURES .EXISTING/PROPOSED OSS COMPONENTS AND LINES
N WELLS WITHIN 100FT E-WATER SUPPLY LINES a DRIVEWAYS/PARKING�,r,, SURFACE WATERS,STREAMS,RIVERS,ETC... Id
RI DIRECTION OF SLOPE/CONTOURS E PERIMETER/CURTAIN DRAINS L'7'NORTH ARROW 'SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) Pc
Si MAY20 2( 25
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER:
COMMENTS 1 CONDITIONS
A id np,v, 2-�ec{fcven s a 5epc trAft k +o co cct- fo e r I!�1, 3-lkdfoon
set, Sr sue► s!kind 44 fti l - b.edrex a, 4-Dv
SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED WITH RISERS
AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLIC PROVED/ISSUED BY DATE
C---- -5(2/(?a76 )0017
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
fr ¶ T -r 4 LOa FT
51-1 TE. C I 0 co _,_--_--------- -�,I
jj
1 GArAczE
�-� 24
I.
1 I
tJ - u —`_,
1 so
-05 IM �
e Noob e a►�L w kTPE j 1C-Nrrek ,1 AaA/L, I
S(-b�E Rc2 S 5-C. 1 io� Rr .� Exrsrird
T, IO(o 1 I N005e I
i BDe'c
71 t 3ktl
Caz:ZT - Fps
1
Sc►,-c I" = 2 0 ,$ r►<. I
1
N O_ t�SEme-KirS o 2
R,o „-..-c- I\w rr(5 i
etsT) UJ ST 1
o SLs-lel ?/o rev 4M
t,t t—iPtVE J ,. '
Q D t?.oADS -(t'ri LATE
try.- ') . - 3� ' DR�CIN FEIt—D Q
i ,.- T s t °Os ACCeSS - 50,
...
pro, v4-j
, /\l EGA l- nk e 2,0
I(18` i ---Pn rn. cr IL
�
Id 2125 C )2`�6I 1
Porce(: z1.z►l- 50 -aoaog L7 17 '
Inc-IuC-�.e5 -� �0
..5„b if
1
MAY 3 0 2025 \.....s
MASON COUNTY ENVIRONMENTAL HEALTI ,'
DJA 1—
1sv3 aad NYV1830VP SIN :31dOS 699L-L89 (09C) lXVd 999L-L89 (09£) :3NOHd
Cr 1-d 000 l• '8 d 000 L N a o 90986 VM'ONfO?!O 3111V8 L60£XOE'O'd
`1-S 00( L S 000 6 lie O313Va0
s, A�,s,N.�YM1�. ig
<�,£L,9 :31VQ,,illit , ., ' I 6 16
.ONI ONI2�GANIONg )
ri
$grV' N 4o A
? S < M p W a nT ��
ir
" 0 �Iy,Y - ifsFQ j... eU' a o d oC� 5:,
z V *
I < . 8
roa3
?m m
a 6
N
eaI
a
ic---- .131;14MICIUMPOUPGSJCP i IL- ON --,,
a III Pg .-..
S -4 •
O f
0
12t1 F.0 ..t".'il I.s t 1`1—.1 V 2E
.+g�'�� N 'O OyII" ,Aali-
1 QU. < 5
�pIeld
•IDp �) 703 s� 4
3g (L " w i
A ppR Div „0,4:— 7............cm_i
"� 4' -1tYJilw JJINI.55 �� 3: j
MAY 3 2025 ; 1. .1 6 ate,.� t 2
e OOO i t S OCO I.59 = y.+u1 u <
MASON COUNTY �� am ag oOF 1 6
ENVIR�h'�AENTAL NEALTI' i.ti— i `
ti a
�8tt 5S 0
ZO n514 a.s
�X��`.3#ari3
8'
b.lj o
N < C yyli d °I V '--
d el
: ::!1:::::
ammo, c1, z[to \ 1 z . _ ter „it . ftg4g6k;
4ICZW0 ,7# i' TE 'ttg "j S'IR:i5,4•1. .?:tg - ., _41.i 514434ip
10
C QO .r yy u d 7 x k�c e,
Q w y sz .. . 6.d b E�2dQv � a 41§' aba te :
!,:. FO1 f N N _ NR;i43 VA
I
F
ll.E..........„...:xi)
g L.. .41.''''-'...-'C'.... '1.'
l' 47 0 ..... -..
•
6 n 424 i . `o
\ kI
o
i i rri
i ---- 1.yL.....; \
i n
{ i C
o _
- , l✓ CP
;. .i ,...._.,, v : p . A: . .. N
v . pp y y R S
. - a ' .Qi .....e. .., P y..}S n. .....:
'I?R, ' '------1 : a i v .1
i P
y 1
,� {I
. ; n , �q v
. .
. 1,
.0. R
y\
italpa i i 11 1 '',4 '!'. 2 i 2: - --i' -1-4
ilelP I 6 1 fi r
i -, a I ;= � '& - R = 4 1J � !:
� �
'Iill • 8 ifi!Yi e , -. 1 1 g ?`' " ( 36
b, R
y Q
1 +yLR 2 ,i 2 o `� �41 • l� s3 ot 4Rx Go
K
51 ioQ, kI3 _ - 2RTA i = -g Lg
a^a� tl y a' a I $
ii
y 7\1_
I t 1 i u,'e sSA
C y
A • . • ...-z-... -4c 8 §L
h3ii i* .,,t q A Pppp,
-i i-- i- ---+ —,N- o `:
0s Ao 2025
A NMFNTAC yFA(Tf
EK ENGINEERING INC. DATE: 6/13/11 TANK COh$TRUGTICN A RE BM SY FDIAE F04 MODELS
DRAFTED BY: 1000 S, 1000 S-T, n
P O.BOX 3097 BATTLE GROUND,WA 98604 D-R N. 1000 P & 1000 P-T
PHONE: (360) 687-7668 FAX: (360) 687-7669 SCALE:
NTS HAGERMAN PRE-CAST