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HomeMy WebLinkAboutSWG2025-00292 - SWG Application / Design - 7/25/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670, EXT 400 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: SWG2025-00292 OWNER COOPERS REAL ESTATE SOLUTIONS Phone: LLC Address: P 0 BOX 66 OLALLA, WA 98359 APPLICANT COOPERS REAL ESTATE SOLUTIONS Phone: LLC Address: P 0 BOX 66 OLALLA, WA 98359 SEPTIC INSTALLER DARREN MILLER* Phone: 360-871-5258 Address: PO BOX 809 MANCHESTER, WA 98353 Site Address: 121 E Little Bear Ln Primary Parcel Number: 320057590073 Permit Description: 3BR tank only Permit Submitted Date: 07/25/2025 Permit Issued Date: 07/31/2025 Issued By: Jeff Wilmoth Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system). Permit Expiration Date: 07/25/2028 (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: Private Well/Spring Additional Details: Permit Conditions: 4 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 2 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 5 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 1 Approval of this septic permit does not approve the building location. Building location is subject to approval from all applicable departments and regulations. 3 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/onsiteloss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY MASON COUNTY DATE RECEIVED: 0 7 / 5 /1 O C (n I.. ,11,, COMMUNITY SERVICES AMOUNT RECEIVED D /—(J O RECEIVED BY W m - Public Health(Community Health/Environmental Health) /� (/) 360 427.9670,ext.400 or 360-275J467.ext.400 (^`A,/'' n ////���' (n Q 415 N.6th Street-Shelton,WA 98584 S /\/1 -. _6'1 b od9 a O 2 J VVV V P� tVVI��� /// Z th ON-SITE SEWAGE TANK ONLY APPLICATION D m m APPLICANT PHONE ' .'t\--3ci S qiA c t PAc41 \tJC. 3 too- j in- St 'Rt(�� z MAILING ADDRESS-STREET.CITY.STATE.ZIP CODE ` 'I �1 ?e 0 c bcc% �AgrnCln.t.S w Pr "18�5 m 0 1 x SITE ADDRESS-STREET,CITY.ZIP CODE 1 1-1 G L.s-4-4-1 e car 1. In 51n-t w;-cn w R 9 8 SS-1 Iu� 1 CV, I V' NAME OF DESIGNER PHONE � 9 I( NAME OF INSTALLER PHONE C �v` ---1 �,.' I O ZOorc�l Mik1t SCG-$1-1-S 2J— 16©J .. ca TYPE OF WORK(select one) DRINKING WATER SOURCE - I o 0 ❑ NEW CONSTRUCTION/UPGRADES 0,REPAIR/REPLACEMENT $. PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z I U'! COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM I PI SEPTIC TANK ❑ PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT�SIZE` I O OTHER 3 , -�T'C— --Z• Aora co OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST Q I CI SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE 0 100FT+PUBLIC/COMMUNITY WELLS 0- I�1 SUBMITTALS CI50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS AI PLOT PLAN(REQUIRED) EtTANK CROSS SECTION(REQUIRED) 0 10FT+DRINKING WATER SUPPLY LINES I4 ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 0 5FT+PROPERTY!EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST 6 I° 0 PROPERTY LINES AND EASEMENTS CI EXISTING!PROPOSED STRUCTURES CI EXISTING!PROPOSED OSS COMPONENTS AND LINES ❑ WELLS WITHIN 100FT 0 WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... 41 ❑ DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS ❑ NORTH ARROW 0 SCALE BAR DIRECTIONS TO SITE AND SITE CONDITIONS:(ex locked gate) p p II ( 1 JUL 31 2025 i NTY EWoJ R0NMENTAL HEPI Tk ED :SSONCO JS� OFFICIAL USE ONLY BELOW THIski: J LINE UPGRADE!FAILURE SOURCE Or reporting purposes) ❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER: COMMENTS/CONDITIONS 5,e{- a c k S - Sd.'-f +O w'C<t Scfi +-o 6outr d•titfdr✓ 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 PLIGATION APPROVED/ISSUED BY DATE 7-3( -a,C -- ` , .. 1-31--;_5 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 7/9/2019 • LSV3-321d NVWH3OVH SIN :31VOS 699L-L99 (09£) 'XV3 899L-L89 (09£) -3NOHd 1-d 09Z 6 '8 d 09Z l- N H o 170986 VM'ONfObO 3111V8 L60£XOS'O'd iii `1-S 09Z 1. `S 09Z L •AS 0313V80 a G,?MAW: �,;Y.,,, ,, LLlEZl9 :31V0 'ONI JNI�133NION > 0.1 Jdh �O tt E -AI Woo z* f'0S'S�`So`tai //4-AI t � o i.- 0 it T 1.2` 4;6 I?p N2s �a:G _ _ j ti:ti q — 83 a o. n 61 g; 7�- / aUM GI-71 — t 2 :88 iiP _ o } .0 o III s f�eop� PN011a v C g�:,. o v . 0 .. , b i _ t e3 _ Ie,y ` I l O 4 63Mp ,l \ \ L o . .vs 1 $ 5 v °in d CSZ' .s osz 1 S9 X {tt S 1 793 $ii u .. o �' u 1) P IA ® iiiv, it rst _ >ju4 31 202' 5gc4Q E o �0 Mv, 1 TYEN NTA �� g A 0. = NQ so 01 I LLSSaNg 4 -off 8 gait z ii .;<�,� o< - w,.., 2 , 9 !r; P,6'.i 0 g'.Vg IMEniai Q t Y 5 d 9`e c,p o jd m � 3 ��uPo am u 01 7 Sitgh oY� _ AQ 9 �, N - v ?n 3n 1SVD-3Lfd NVY`1' Vk SIN .31VOS 699L-L89 :09£) :XVd 999L'L99 (09£) :3NOHd ' 1-d OSZ t. '8 d 09Z 1. 1,111.G Dc996 dM'aNno210 3111V8 L60£XO8 O'd ill '1-so9z� SO5ZI ASa31d�f2ia .�NI JNI2���NIJN� xi, d $130O1N tIOJ 3t(YJ3Ws YIV6-3tl t vpt3/1t11SvO WW1 L/£Z!9 :31v'a i'' a I .a .....= >r>........a�. .► • X 1 6q Y q t �O, . F rg 3 , ,, �jp�, .qa.ajj Y F �`" i0 4�tg Y SI I,tly 1 OFF iiiii S t b I1 m : - - €i-& �: n •= a • 7 a QJ y oY C> 1 , • ; , Nvi Sz, 5:4 ..--,1, 4, asb,. v t5,ei, -- ? r / t ..: - v :� say - t: ., , o II !! F I t } ii. Ztt Y _ ii< ? r. t 3igit. ll �I p 3 3- . vS O,. I F F t 1 I I I I 1 F a Y I 11I 1 4 .w I F as 1 v'F ' 1 I I 1 n c t n a j . • 1 n Y I I i• t I Y 1 I i NI i...-. T i • •V i i 4, 1 0 / ' N 0 % 0 Y • 0 ' ' I Y I 'i 1 L---«- 1 I. o N`5 e I ° ...rxa i1 7 •i i . ii N § 1• jj I / i 5C i 0 \ .} r }- -I -, . . F / O A Y G . . J / t L' C C^ cZ I a�.. C I t 0au OI v; M I }....} =X.} L }....a.i�w�1 tj c }_ 4 Q L r 1 0 0 i 1 ' ' ~ 0 ' $t'il I 9 Y I Y N I . �[ . t - c4 cc 0. = ONO .. �G i i )`. 1v_ jZ 1= i eI i vvi i ccc cN „ t w e4 1 Ob , _ F i `r t; b I I n Shht ar _ _ _ 5e • 1 .)Ut 31 2025 'z` MASON COUNTY ENVIRONMENTAL HEALTH . JBW THURSTON-MASON HEALTH DISTRICT -,44- -- • _z 529 W.4TH PHONE 75.3 17-73 .. P.O. BOX 746 110 W."K" ST. PHONE 426-4407 OLYMPIA,WA 98501 SHELTON,WA 98584 RECORD OF FINAL INSPECTION OF YOUR SEWAGE DISPOSAL SYST C ; v� r.) OWNER ` )$II I)).4 •" PARCEL NO. C� I :? ��i� ADDRESS f ri TOWNSHIP RANGE SEC. 7-1-. 10 33x sig.? A e !+Q k THURSTON-MaSrnr NAME OF( �) j� fiEAl_�bT^ 'SRICT THIS RECORD IS NOT A GUARANTEE OF PERFORMANCE. PLAT 1 ���y,, 01,2411 Y,�- NO. (-� A SEPTIC SYSTEM IS NOT A MUNICIPAL SEWER. HOWEVER WITH PROPER MAINTENANCE AND CAREFUL USE OF SOIL ��)) :- �l�i .) COMMENTS AA.,H..41A- P•e-<K ) 2. ki. WATER IT CAN GIVE MANY YEARS OF TROUBLE FREE SER- AERATION VICE. MANY PROBLEMS WITH SEPTIC TANKS ARE CAUSED SITE.. ��i S�IS Xj/ V-"ei CI • BY FLUSHING EXCESSIVE AMOUNTS OF PAPER, CLOTHNO 11 (( AND PLASTIC MATERIALS DOWN THE DRAIN, OR BY LARGE DEPTH TO MONTH SAND AMOUNTS OF WATER FROM LEAKY FAUCETS OR FAULTY WATER TABLE I<{(,f OF YEAR FILL FIXTURES. INSTALLER '} THE SEPTIC TANK ITSELF SHOULD BE CLEANED EVERY SIZE TWO OR THREE YEARS DEPENDING ON THE HABITS OF THE SEPTIC TANK IS) t;i.(;` (��^+ . cz ^2' FAMILY, THE NUMBER OF FIXTURES IN THE HOUSE, AND DRAINFIELD TOTAL FEET THE AMOUNT THAT A GARBAGE DISPOSAL IS USED. LENGTH CLEANING AT THE RIGHT TIME WILL AVOID THE RISK OF TRENCH AREA TOTAL SQ. FT. INJURING OR DESTROYING THE DRAINFIELD DUE TO � ���JO !L- �� / 7 SOLIDS CARRYING OVER INTO THE DRAINFIELD. CALL THE TILE THURSTON-MASON HEALTH DISTRICT FOR A LIST OF LIC- DEPTH ❑ CORRUGATED ❑ SOLID ❑ CEMENT ENSED SEPTIC TANK CLEANERS IN YOUR AREA.THE CLEAN• ER CAN SERVE YOU BEST IF YOU SHOW HIM THIS RECORD ROCK s, �r �Y r� ) INCHES WHEN HE COMES. �CU. YDS. I r '' K I 7.c ` DEPTH HEAVY TRUCKS OR EQUIPMENT SHOULD NEVER BE SPACE E RESERVED NT DISFOR BUTION FIELD: SQ. FT. DRIVEN OVER THE TANK OR DRAINFIELD. CONSULT THIS RECORD IN CASE ANY BUILDINGS, DRIVEWAYS, SWIM- 4NORTH. ... ` �... . ••. a••�-•• m -w �< MING POOLS, OR EXTENSIVE GRADING OR FILLING ARE LATER CONTEMPLATED. i.. ...;..;,..i. .k... .;.........:...f.....; ..:._•t. ;. .. ..1 SHRUBS OR TREES SHOULD NOT BE PLANTED CLOSE TO . ...;.!...:....;......: ........_;..,.;..-...;....:...., THE SEPTIC TANK AS THEY WOULD INTERFERE WITH . , 1 s.. ": : : , • CLEANING OF THE TANK. THEY CAN BE PLANTED IN THE • _ • 's :.. .i..;......'... DRAINFIELD AREA PROVIDING WILLOWS ARE NOT USED. `�H� �,, t I • ;•• �--�•..Y..- ' • THE YARD GRADE IN THE DISPOSAL AREA SHOULD BE SUCH THAT SURFACE WATER IS NOT POCKETED ON THE DRAIN- .i f . • . ... FIELD. ANY SETTLING OF THE GROUND OVER THE TREN- - -.•- ,,.r _.: -• ;. CHES SHOULD BE FILLED IN WITH SOIL. DO NOT EXCES• I SIVELY WATER THE LAWN IN THE DRAINFIELD AREA. • - WATER EVAPORATION FROM THE DRAINFIELD IS ABOUT 1 S_... aY EQUAL TO ONE HALF INCH OF RAIN PER DAY. FOOTING DRAINAGE, DOWNSPOUTS AND WATER z (j` �F"" WATER SHOULD NOT BE CONNECTED r SOFTENER RECHARGE • � v NPOP is--..7.. N� INTO THE SEPTIC SYSTEM OR DISCHARGED INTO THE DRAIN- :=gt•`-. �- 7., 7. �� , w-,ESA-. ..,. . FIELD AREA. N����`� THE TYPES OF BACTERIA NEEDED IN A SEPTIC TANK ARE ���� nn� ALWAYS FOUND IN SEWAGE. THERE IS NO NEED TO ADD • O�C,O t w YEAST OR OTHER STARTERS TO A SYSTEM. THE USE OF RE- ,a .j i /10,4., �P , .. JUVENATORS OR CHEMICALS TO CLEAN A SEPTIC TANK HAVE NOT BEEN PROVEN TO BE BENEFICIAL AND MAY 4., BE HARMFUL BY FLUSHING SOLIDS OUT OF THE TANK OR • BY CHANGING THE CHARACTERISTICS OF THE SOIL. THE w_.__� ., V_; ... SOUTH NORMAL USE OF BOWL CLEANERS OR CLEANING COM- , 4 ' •-•i••'•--I : .•. - I ` : POUNDS WILL NOT KILL THE BACTERIAL ACTION OR SLOW _ DOWN THE OPERATION OF THE SEPTIC TANK. �,pL l• �-- _ I Q .S t It, DATE APPROVED BY � THIS IS AN IMPORTANT DOCUMENT j--a ', 7 ^ 'h' P,IT WITH DEED OR 0 R^ CERTIFIED BY Printed 11' k ESSENTIALPAPERS.0 C�UC�I�I VIVI OM I Printed from Mason County DMS PARCEL NO. .a,I�- � 1...,' 4 SITE N0.5 (o .A- 4 THURSTON-MASON HEALTH DISTRICT DATE BASIS FOR FEE AMOUNT RECEIPT NUMBER DIVISION OF ENVIRONMENTAL HEALTH C_a- 1. ,L-k `I )5 GO- C5 Qo 529 WEST FOURTH 110 W.K ST P.O.BOX 746 \J t PHONE 753-8073 PHONE 426-4407 OLYMPIA,W��A//��ss98//5��01 SHELTON, WA 98584 • OWNER F A/Yle A G( u-es/` P.O. PH NE TOTAL D ,/ I/ DIRECTIONS TO SITE: /��.c x7; " /Y�NFr - FEES par=ohi),_~«i y 7 70;44 : yrj A. 09 1, `afiis . h`"��� �1 Qec--4-�.h _ �,f, SEWAGE A i 0-VN CONTRACTOR A/0 NL'� ' ADDRESS OR LOCATION NAME OF PLAT LOT •• :' " NO. SOIL TYPE Cirt-d "may r a TOWNSHIP 20 ki RANGE 3 vJ SEC. DEPTH TO WATER TABLE FT. WATER SOURCE [1 PUBLIC APRIVATE PERC. TESTS: INCHES PER HOUR • TYPE OF C LOT �.��1C C. BUILDING �U > BASEMENT "Q SIZE X BY: DATE NO.OF NO.OF GARBAGE PRIMARY SECONDARY BEDROOMS BATHS I �� DISPOSAL N O SEPTIC T NK( C' �AL. A /ATTIION��.(� GAL. � r 1 � -v" SPACE RESERVED FOR REPLACEMENTS DISTRIBUTION FIELD SQ FT. . DISTRIBUTION TILETOTAL go FEET 4 NORTH - SITE PLAN AND SPECIAL STIPULATIONS: TRENCH BOTTOM AREA /VC./ SQ. FEET ;. .:....;_..; ; . • • QUANTITY OF : APPROVED STONE-7-CU. YD. SAND CU. YD. y- FILL REQUIRED CU. YDS. 4 I •.. • 04 I ELEVATION OF THE BUILDING SEWER SHALL BE SUCH THAT ••, THE THE MAXIMUM DEPTH OF THE DISTRIBUTION TILE SHALL BE BE- TO - . . .'..; r - I / - TOP OF1 TILE UNLESS OTHERWISE2 INCHES AND 36ES STIPFR�ATEDMIBYED TT THE EADE ALTHH I ..:• .••. t$' I - I OFFICER. IF THE ELEVATION OF THE BUILDING SEWER IS TOO LOW TO MEET THESE ELEVATIONS,A SEWAGE EJECTOR MAY BE REQUIRED • ` ISOLATION STANDARDS FOR PRIVATE WATER SUPPLIES: v� ill BETWEEN WELL AND TANK OR ANY PART OF THE TILE FIELD, • 100 FEET FOR SINGLE RESIDENCE, MOBILE HOMES, DUPLEXES I AND MULTIPLE DWELLINGS. NO DRAINFIELD WITHIN 100 FEET : .'.. .,... •. :.a_.;..•i.._. •- ANY OF ANY WATER BODWA WATER LAKE OR STREA 00 FEET FROM Y. 1 °" I • i A DOWNSPOUTS, WATER SOFTENER AND ANY • NUTE 'FOOTING DRAIN GE r "i ' HER TE TE T NE AS WAGE SHALL NOT BE CONNECTED l OT WAS WA R NO DEFT D SE } `= OR DISCHARGED INTO THE SEPTIC TANK SYSTEM OR THE SEWAGE DISPOSAL .•4"'.1.,.;.. .,.ti.. .i,.-•.":-: 1 : i•-•Y -'-•=-• ••. . • AREA". ALL SEWAGE, INCLUDING SINK AND LAUNDRY WASTE, MUST BE , t -t�'; ;...a-.,..._I_.7..,_.;._.i- 7 i-l•.-;--w-._.•4. .._p...:.. CONNECTED TO THE SEPTIC TANK. "•• ••..1.•-F .f...I : ,i ' . • ' FINAL INSPECTION REQUIRED BEFORE BACKFILLING t...../l._.y...-L_i_... .-.-..j_; . . -4-• j B KFI LED OFFICE USE ONLY TO BE AC L ek,(t•. " AFTER INSPECTION DATE APPLICANT MUST CALL FOR INSPECTIONS LISTED BELOW 41 12"TO 24" NOT 1 SITE: APPROVED ❑ APPROVED 2 STRAW icr-'S '...• BY:/ / Jo,/L� s �J'//,444 •S;':��-,'��i :;�!C"+;�;• ;,,..s•tS 2 STONE r ` NOT `,v- ar- : o,„. I�`� '4il/'A OVER TILE SEWAGE ❑ APP VED ❑ t't.'..i.'%• �!'••r t APPROVED ✓'�%,•0,,`'Y;• 's.0 4••�I BY ��%:C i:,-1,'.�4f.1 ft 4, F —0 lJ STONE � �.eit11. �4 +pia:, UNDER TILE WATER: O APPROVED SOI 1jU BY: J I 5.:. • PROVED rr'Ff" CROSS SECTION OF TRENCH ©" Printed from Mason County DMS