HomeMy WebLinkAboutSWG2025-00305 - SWG Application / Design - 7/31/2025 415 N 6TH STREET,SHELTON,WA 98584
MASON COUNTY SHELTON:360-427-9670,EXT 400
BELTON:360-427-9670,EXT
61,,,. .: ELMA:360-482-5269,EXT 400
Public Health & Human Services FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2025-00305
APPLICANT potter,bennett Phone: 3608704970
Address: 620 93rd ave se olympia,WA 98501
RACKLEY WINDY MONTERO& Phone:
OWNER JEFFREY PAUL
Address:
1131 E PHILLIPS LAKE RD SHELTON,WA 98584
SEPTIC INSTALLER
BENNETT POTTER" Phone: 360-943-9200
Address: 620 93rd AVENUE SE OLYMPIA,WA 98501
•
Site Address:
1131 E PHILLIPS LAKE RD
Primary Parcel Number: 220055000032
Permit Description: Replace septic and pump tank and rebuild Glendon pods
Permit Submitted Date: 07/31/2025
Permit Issued Date: 08/06/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid:
$270.00 (additional fees may be required upon installation of system).
Permit Expiration Date:
07/31/2028 (based on date of Inspection)
Type of Work OSS Repair
Components being Replaced: Septic and Pump Tanks
Surfacing Sewage? No Existing Failure? No
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 3 Drinking Water Source: Private Two-Party Well
Additional Details: Rebuild glendon pods also.sand on top bio matt
Permit Conditions:
3 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
1 Approval of this septic permit does not approve the building location. Building location is
subject to approval from all applicable departments and regulations.
4 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for ;
final installation approval. 1
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
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/healthienvironmental/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
DATE RECEIVED. O - !��
MASON COUNTY g " 0
COMMUNITY SERVICES AMIXINTRK IREC€NtOOY:70 o m
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ON-SITE SEWAGE TANK ONLY APPLICATION > R'
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APPLICANT PHONE r'
A-action Group Utilities Inc 360 943 9200 � Z
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I AlLINOADDRESS-STREET,Cifl'.STATE,TIP CODE Q CO
620 93rd Ave SE ti 9
SITE ADDRESS-STREET,CITY,ZIP CODE V
hE1131 Phillips Lake Road Shelton WA L/\�.r��J Q � 'I --
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NMIEOFDESIGNER PHONE v Q \, 1 X ,
NAME OF INSTALLER PHONE �� G Io
A-Action Group Utilities Inc-Ben Potter 360 870 4970 cell N I Q
TYPE OF WORK(soled ono) -r DRINKING WATER SOURCE
❑ NEW CONSTRUCTION/UPGRADES ill REPAIR/REPLACEMENT I] PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z I0\
COMPONENT(S)TO BE REPLACED/INSTALLED CI PUBLIC WATER SYSTEM I yh_ I/j�1 SEPTIC TANK ( PUMP TANK CI RV HOLDING TANK BEDROOMS LOT SIZE O j n
d
❑ 3 OTHER "U� F-3 I 0
OTHER DETAILS(salad oathat apply) TANK(S)SETBACK CHECKLIST 8 I
❑ SURFACING SEWAGE CI EXISTING FAILURE ❑SHORELINE ❑ 100FT+PUBLIC/COMMUNITY WELLS x ID i
. NI SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
SUBlIITTALS 0 10FT+DRINKING WATER SUPPLY LINESI C
®PLOT PLAN(REQUIRED) ®TANK CROSS SECTION(REQUIRED) 0 SFT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
❑PUMP DETAILS(IF APPLICABLE) ❑WAIVER(S)(IF APPLICABLE) r.
PLOT PLAN CHECKLIST 0
II® PROPERTY LINES AND EASEMENTS ® EXISTING/PROPOSED STRUCTURES NI EXISTING/PROPOSED OSS COMPONENTS AND LINES 1
MI WELLS WITHIN 100FT ®WATER SUPPLY LINES II DRIVEWAYS!PARKING El SURFACE WATERS,STREAMS,RIVERS,ETC... {Ar/I
® DIRECTION OF SLOPE/CONTOURS ®PERIMETER/CURTAIN DRAINS IN NORTH ARROW IN SCALE BAR 193
9 3 I
DiRECTKONS TO SITE AND SRE CONDITIONS:(ox.locked gate) J`�
Existing
OFFICIAL USE ONLY BELOW THIS LINE
•
UPGRADE!FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER: / _
///Tr
COMMENTS/CONDITIONS ( n(C(`v PIPIA)
QZ47' 602/ SOrcinl- ar Y U ►\A egfekuton
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
_____. cDt 6 t-1,0" ttriOrlycorl W6f/A THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
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