HomeMy WebLinkAboutSWG2025-00245 TANK ONLY - SWG Application / Design - 6/26/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
I. 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: SWG2025-00245
OWNER DOGWOOD PINES LLC Phone: 360-584-6419
Address: 1827 LAKEHURST DR SE OLYMPIA, WA 98501
SEPTIC INSTALLER STEVE PERSCHON* Phone: 360-357-4272
Address: PO BOX 11265 OLYMPIA, WA 98508
SEPTIC DESIGNER Adam Hunter-Jim Hunter and Phone: 360-753-1226
Associates
Address: PO Box 162 OLYMPIA, WA 98507
APPLICANT STEVE PERSCHON* Phone: 360-357-4272
Address: PO BOX 11265 OLYMPIA, WA 98508
Site Address: 201 SE Lazy Dog Ln
Primary Parcel Number: 220297500010
Permit Description: Tank Only: Reset depth of four(4) existing tanks (two-bdr SFR (1),
studio w/ bath (1), and main tanks adjacent to the drainfield (2))
Permit Submitted Date: 06/26/2025
Permit Issued Date: 07/02/2025
Issued By: David Anderson
Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/26/2026 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic and Pump Tanks
Surfacing Sewage? No Existing Failure? Yes
Shoreline? Yes Horizontal Setbacks Met? Yes
Number of Bedrooms: 6 Drinking Water Source: Private Well/Spring
Additional Details: PULL AND RESET 4 TANKS (1 SEPTIC TANK, 1 PUMP CHAMBER
AND 2 COMBINED SEPTIC / PUMP TANKS)
Permit Conditions:
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.gov/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
MASON COUNTY 415 N 6TH STREET,SHELT967 ,E 98400
SHSTREE ,SHE TON, ,EXT584
J L BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County 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.gov/health/environmental/onsitefoss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
DATE RECEIVED: /
MASON COUNTY tt-- z6' ?0 2f-
.I I. COMMUNITY SERVICES AMOUNT RECEIVEO RE:FIVEDBY /
270 0�(/� W Cl)
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Public Health(Community Health/Environmental Health) Cl)
360.427.9670,ext.400 or 360-275.4467,ext.400 I1 /� / ) /�
415 N.6th Street Shelton.WA 98584 s\A�/ - 207 5' — / / Z U,- Z 2
ON-SITE SEWAGE TANK ONLY APPLICATION
m n
APPLICANT PHONE m
I—
STEVE PERSCHON 3607017303 z
MAILING ADDRESS-STREET.CITY,STATE,ZIP CODE
201 SE LAZY DOG LN, SHELTON, WA 98584 m
SITE ADDRESS-STREET,CITY ZIP CODE
201 SE LAZY DOG LN, SHELTON, WA 98584 V
NAME OF DESIGNER PHONE 8
ADAM HUNTER 3607531226 cc, <Dcjr
NAME OF INSTALLER PHONE
SEPTIC SPECIALISTS 3607017303
TYPE OF WORK(select one) DRINKING WATER SOURCE O O
❑ NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL z
COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM
O SEPTIC TANK ❑O PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE
❑ OTHER _ 6 5.06 W
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r
O
❑ SURFACING SEWAGE El EXISTING FAILURE 0 SHORELINE 0 100FT+PUBLIC/COMMUNITY WELLS 0
SUBMITTALS
❑� SOFT+PRIVATE WELLS,SURFACE WATERS.STREAMS.RIVERS
O PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) 0 10FT+DRINKING WATER SUPPLY LINES
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 0 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
(-
PLOT PLAN CHECKLIST 0
0 PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES O EXISTING/PROPOSED OSS COMPONENTS AND LINES -I
O WELLS WITHIN 100FT 0 WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC...
0 DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
ARCADIA TO NORTH ON LAZY DOG LN STAY LEFT AT THE "Y" TO SITE AT THE END.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE 0 COMPLAINT ❑OTHER:
COMMENTS/CONDITIONS
(5e{- doh of 'a,„. ( i) ex Maly frolics (2-bcir ('), *kb 1.( bafh(i), and mot+
+a+?ks «ctjaca*tf Gfrarvifieklct) ).
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 APPLICATI PPROVED/ISSUED BY DATE
6 (ZC(Zo ZC. 7(7(?al r
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
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