HomeMy WebLinkAboutSWG2025-00316 - SWG Application / Design - 8/7/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
01114 , 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: SWG2025-00316
OWNER WESSNER HARRY C & MILDRED E Phone:
Address: 1383 OLD GARDINER RD SEQUIM, WA 98382
APPLICANT WESSNER HARRY C & MILDRED E Phone:
Address: 1383 OLD GARDINER RD SEQUIM, WA 98382
SEPTIC INSTALLER AARON SHUMAKER* Phone: 360.509.1222
Address: PO BOX 3378 BELFAIR, WA 98528-3378
Site Address: 470 E RASOR RD
Primary Parcel Number: 122064201000
Permit Description: Septic tank replacement
Permit Submitted Date: 08/07/2025
Permit Issued Date: 08/07/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 08/07/2028 (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: Public Water System
Additional Details: Hagerman 1250 ST
Permit Conditions:
3 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
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.
4 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
1 Approval of this septic permit does not approve the building location. Building location is
subject to approval from all applicable departments and regulations.
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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
MASON COUNTY DATE RECEIVED: OV](� ' O1 ' P.-Ca`� N D
c v,
COMMUNITY SERVICES AMOUNT RECEN RECEIVED BY: CO Cn
Public Heath(Community Health/Environmental Health)
-' - 415 N.6th Street
et•4W oon,WA 8584 e.t.4ee SWG n b^y� ,.�/�3I y (/� Q
415 N.6th Street•Shelton,WA 95984 �V�[`. `/.�L�_/) /vH�/\ ` O 73
Z ui
ON-SITE SEWAGE TANK ONLY APPLICATION
m n
APPLICANT PHONE mr
Wessner Harry C & Mildred E 360 643 9116 �/� z
MAILING ADDRESS-STREET.CITY,STATE.ZIP CODE C
1383 Old Gardiner Rd Sequim Wa 98382 h COZ.
SITE ADDRESS-STREET,CITY,ZIP CODE /1rQ.. �/ I
\)/
470 E Rasor Rd Belfair `V\�/
NAME OF DESIGNER PHONE J •
I N
Q
NAME OF INSTALLER PHONE Q 0 I N
Shumaker Construction 360 509 1222 bl,
1 TYPE OF WORK(select one) DRINKING WATER SOURCE v O O
' ❑ NEW CONSTRUCTION/UPGRADES • REPAIR/REPLACEMENT ❑ PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z I 1)
COMPONENT(S)TO BE REPLACED/INSTALLED PUBLIC WATER SYSTEM l
III SEPTIC TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE I .A
❑ OTHER 3 6.36 I N
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST
n t
❑ SURFACING SEWAGE •EXISTING FAILURE 0 SHORELINE • 100FT+PUBLIC/COMMUNITY WELLS I O
SUBMITTALS 50FT+PRIVATE WELLS,SURFACE WATERS.STREAMS,RIVERS
• PLOT PLAN(REQUIRED) ■ • 10FT+DRINKING WATER SUPPLY LINESTANK CROSS SECTION(REQUIRED) I
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) • 5FT+PROPERTY!EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST 6 I O
▪ PROPERTY LINES AND EASEMENTS (III EXISTING/PROPOSED STRUCTURES •EXISTING/PROPOSED OSS COMPONENTS AND LINES
❑ WELLS WITHIN 100FT • WATER SUPPLY LINES ❑ DRIVEWAYS/PARKING •SURFACE WATERS,STREAMS,RIVERS,ETC... I O
• DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS •NORTH ARROW •SCALE BAR I
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex locked gate)
From Hwy 3 turn left onto State Route 106 continue to Left on Rasor Rd. Continue to Right
470
---------- — OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT OHOME SALE ['COMPLAINT ['OTHER:
COMMENTS/CONDITIONS
i(— ,r-fe,,nV........._ \ a,GMci2 —
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 APPLICATION APPROVED!ISSUED BY DATE
CZi'1 I L(e) 014 l-7Iz
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
- � � --And
tiro 44,(
74'
I 2. Drwtw
2(.' R,-sof
C o''wm.
t.)444,Sys h r.
; 'co'
NSciAe—
470 F. R4
l2206" _ di - b (000
(JU.�SSvket Narr kjteak
•
APPROVED
AUG 072025
MASON COUNTY ENVIRONMENTAL HEALTH
RET
1SVJ-a M/W iao SIN Ltd .31yOS 699L-L99 (09E) :XVJ 999L-L99 (09E‘) :3NOHd
1-d OSZ 6 I? d 09Z I. •N•a•° bo996 VM'°Nf10N'J 3711b'9 L60E X08'O'd
w •.l-s osZI, `S oSZ� ^e°3�'�° •�NI ONI�INIJN� �I�
dS13m01000>>Yi-ems Haas 01.nn.SM�')N4ti_ LL/EZJ9 :31y0
T
S3 �`` z. Ir
l < r
_ 3- �L
. i
1-N Y ■ ----....1
c F.oft a -
r
f� •. ba
•
al- .Y fit
1 Y
1( I b ...... Ng !` . k iY 2.
Y., !YZ 8 K
s � i [oc Y <?
t.d "N ♦g V C 4 22 f` i ti s as:, S
S::, is y, ^ O vt r•Ly L� 3 !, :fitl .
aS e(p Oi ;PE.gT t S{` d' X 1 1 .k Y i g Y t _rg
j lug a^ r/ ■',
✓ 'o{ A T
z D Tv
.:..-.:....
: a--•-4. •t .. ►._.._..._ .. C N
■ ! 1 1 ■ 0 s I N C
N v 1 1
,.... . L try
1 L 1 1 II 1 X.
/ 1 , 1 r
■ 1 ■ II
Am. 410
3 II
■
1 ■ 1 1 ■ ■
!------ -
C n ri i ■ 1 y x 11 I • I i 3 1 I* j tF..,.
E o u a 1
•
Gnr. NQ � ■ wa
i i 1YK n ° 0
z s o 3 i 1 ;'f ■
1 1 Y p ■
■ n 1
.T. iiiYYYY y-• is.8
•
Y
•
1SYO-323d NVYRi3f1V1-1 SIN :31VOs 699L-L99 (09£) :XVd 999L-L89 (09£) 3NOHd
Tr
1-d OSZ L V d OSZ I. N a'O 170996 VM'ONf1OND 3111V8 L60£XO8'O'd
Li `1-S OSZ L 'S OSZ L A8 031dVa0
O. 4,370M W,�,n: WW1I.L/£Z/9 :31V0 'D N I J N I H 3 2 N I J N 3 )
. I
„ col 6.1.4
-\
` V1}� i Af.Z
,.� M JI1
. '4 ,, 4, !91.'t 5 '"7 7.C.: 9 0eig9C1,'
J H
y30 ` °> N VV6yv '•f
F .. di0 35'it>gi•-'`ri
i .,
I 4r: \\\ e'y ve1 K
V�� '-3"_ Ica R i
u _ `\,`) d` uA ry
` IN? H
JI L gi z9116 �—
mi
J O �1 -I i l l oY r
III 1 ie i u r3°
' J
i
I
`ups yQdig- x ?D 8 p.,4
QUO I �'°+ -' !i tr- �- �i�Kt
K I a Qk . ,L `d�d7 S j J1 C 1 �qC ty �� Nzh !4 2E1`` k
GL: 11 M•O �jA11ii�
J� 1t.�n AO _ C ' 7
8 � g
S a O L
<a 3.
g71.: ! a
3 N
nil0 ? r 1p Z
-_
z3 I s
.'.irt .
E . � C -I!13N lalNl A4 4 K zh
► o I.99 �--zr
Cy � - W— NF Q ;r- I N .
731
oM thOu
1 bh
ioH
Z 3 O t;ItllHI !
syy 1.9 '
C W �ag "���+ z ... to.- 2.-., 0 sum =iNbi b'-}�S
V 4 C. h 1 ' J tab < 141?; .wg'�QQyy a i rtilbt•k1on
o . a8�° 16 W % ,2,a�2Ssuz nb y Q �a �3 S3�N:�`1�a1
ci.
c I _ iw
2_ zv M. ,-,._
I
1
l