HomeMy WebLinkAboutSWG2025-00232 - SWG Application / Design - 6/20/2025 : MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHEL70N:360-027-9670,EXT 400
L 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: SWG2025-00232
APPLICANT DORPAT ET UX NORM Phone:
Address: 267 SCHOLZE ST LEAVENWORTH,WA 98826
OWNER DORPAT ET UX NORM Phone:
Address: 267 SCHOLZE ST LEAVENWORTH,WA 98826
SEPTIC INSTALLER Royal Flush Phone: 3607903021
Address: P.o.box 1336 Hoodsport,WA 98548
SEPTIC INSTALLER DARIN OGG* Phone: 360-790-3021
Address: PO BOX 1336 HOODSPORT,WA 98548
Site Address: 80 N SUNCREST DR
Primary Parcel Number: 422142100163
Permit Description: Septic tank replacement
Permit Submitted Date: 06/20/2025
Permit Issued Date: 06125/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $270.00 (additional fees may be required upon Installation of system).
Permit Expiration Date: 06/25/2026 (based on date 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: 3 Drinking Water Source: Public Water System
Additional Details: Hagerman 1250 ST
Permit Conditions:
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County 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.
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
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.govlhealth/environmental/onsiteloss-Inspection-request.php or call:
360-427-9670, extension 400.
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SITE ADDRESS-STREE, 'T.qr ZIP CODE ,y,
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NAME OF DESIGNER PHONE
NAME K0 74< +/Ids4 ,S'c (ec 3 o 7qo 5o 2 (i, PHONE C'1
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TYPE OF WOW Imo) DRINKING WATER SOURCE
❑NEW CONSTRUCTION/UPGRADES KtEPAIR!REPLACEMENT PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z C'
COMPONENT/SI TO BE REPLACED!INSTALLED PUBLIC WATER SYSTEM f r
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OTHER DETAILS(mkd d that TANKS)SETBACK CHECKLIST
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Cl SURFACING SEWAGE XISTING FAILURE ❑ ❑ 10 SHORELINE 0T7a PUBLIC)COMMUNITY WELLS N' C) I
SUBMITTALS ❑ SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS 0
ii,1 PLOT PLAN(REQUIRED) ti(TANK CROSS SECTION(REQUIRED) P10T+DRINKING WATER SUPPLY UNES O
❑PUMP DETAILS(IF APPLICABLE) ❑WAIVER(S)(IF APPLICABLE) 6FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST r
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❑ PROPERTY LINES AND EASEMENTS ❑EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES -'
❑ WELLS WITHIN 100FT 0 WATER SUPPLY LINES 0 DRIVEWAYS!PARKING Cl SURFACE WATERS,STREAMS,RIVERS,ETC... ir
O DIRECTION OF SLOPE/CONTOURS CI PERIMETER/CURTAIN DRAINS iik NORTH ARROW Ill SCALE BAR
DIRECTIONS TO SITE AND SITECONDMONS(sr-kdedgat,)
- - - OFFICIAL USE ONLY BELOW THIS LINE - --- -- -_
UPGRADE!FAILURE S (for reportbig purpoees)
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0 VOLUNTARY MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER
GOIAYETTSICONDMONS
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SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS'.TANKS MUST MEET CURRENTMIN/MUM ME 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 APPLICATION APPROVED/ISSUED BY DATE
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REWS»1 M2015
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RECORD DRAWING (continued)
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EK ENGINEERING INC. 'DRAFTS BY:-I 1250 S, 1250 S-T,
P.O.BOX 3097 BATTLE GROUND.WA 98604 D.R.N. 1250 P& 1250 P-T
• PHONE: (360) 687-7688 FAX: (360) 687-7669 SCALE: A
NTS i HAGERMANPRE-CAST
•