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HomeMy WebLinkAboutSWG2025-00306 - SWG Application / Design - 8/1/2025 • MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 J 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: SWG2025-00306 APPLICANT JEFFERY ROBERT W Phone: Address: 323 SE STOTSBERRY RD SHELTON, WA 98584 OWNER JEFFERY ROBERT W Phone: Address: 323 SE STOTSBERRY RD SHELTON, WA 98584 SEPTIC DESIGNER MICAH HALVERSON** Phone: 406-490-1549 Address: PO BOX 698 ELMA, WA 98541 Site Address: 323 SE STOTSBERY RD Primary Parcel Number: 320234700080 Permit Description: Septic tank replacement for original SWG permit#7258 (most southern tank on property) Permit Submitted Date: 08/01/2025 Permit Issued Date: 08/05/2025 Issued By: Rhonda Thompson Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system). Permit Expiration Date: 08/01/2028 (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: 4 Drinking Water Source: Private Well/Spring Additional Details: New 1050g tank (1 of 3 on property) Permit Conditions: 3 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 4 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 5 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 2 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval 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. 6 Designer/installer to correct any issues with D-box and document in asbuilt 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/healthlenvironmental/onsite/oss-inspection-request.php or call: 360-427-9670, extension 400. ' OFFICIAL USE ONLY v RECEIVED:MASON COUNTY DATE RECEIVED: S - 0 l " Q . D 07 COMMUNITY SERVICES AMOUNT RECEI E C fn RECEIVED W (n v m Public Health(Community Health/Environmental Health) C (n 360-427.9670,ext 400 or 360-275-4467,ext.40) '' /� ` /�� (n 41 S N.60,Street-Shelton,WA 98584 S W G / I W 3\/L/) �_ 11I1 /Vy`- -�Ir/ 0 Z (n ON-SITE SEWAGE TANK ONLY APPLICATION a v m n APPLICANT PHONE m r JEFFERY, ROBERT W 612-309-1554 z MAILING ADDRESS-STREET,CITY,STATE.ZIP CODE E al 323 SE STOTSBERRY RD Shelton Via ': 4, min SITE ADDRESS-STREET,CITY,ZIP CODE '�"► t 14I \.\t t Same as Mailing ci i.',;.,•..,:. \ 1I NAME OF DESIGNER , i ° ' PHONE ivMicah Halverson ,1V', 0 O 360-490-6365 NAME OF INSTALLER `1Li t / PHONE O v Unknown iiy ,•.• N I N TYPE OF WORK(select one) DRINKING WATER SOURCE 0 ❑ NEW CONSTRUCTION/UPGRADES ® REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z I CO COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM 1 © SEPTIC TANK 0 PUMP TANK ❑ RV HOLDING TANK BEDROOMS LOT SIZE I -p ❑ OTHER 4 1.6ac co • OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST Q CI SURFACING SEWAGE MI EXISTING FAILURE PI SHORELINE ® 100FT+PUBLIC/COMMUNITY WELLS T` I O SUBMITTALS ® 50FT+PRIVATE WELLS,SURFACE WATERS.STREAMS,RIVERS CI PLOT PLAN(REQUIRED) ®TANK CROSS SECTION(REQUIRED) ® 10FT+DRINKING WATER SUPPLY LINES I O ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) ® 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST 6 I C O PROPERTY LINES AND EASEMENTS © EXISTING/PROPOSED STRUCTURES (II EXISTING/PROPOSED OSS COMPONENTS AND LINES 0 WELLS WITHIN 100FT IllWATER SUPPLY LINES ® DRIVEWAYS/PARKING illSURFACE WATERS,STREAMS,RIVERS,ETC.. I CO I] DIRECTION OF SLOPE/CONTOURS ® PERIMETER/CURTAIN DRAINS IIIII NORTH ARROW ® SCALE BAR O I DIRECTIONS TO SITE AND SITE CONDITIONS.(ex.locked gate) From Shelton turn onto SE Arcadia Rd. travel to SE STOTSBERRY RD. continue to the end of Stotsberry to subject parcel. I — OFFICIAL USE ONLY BELOW THIS LINE -- UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ['COMPLAINT ['OTHER: ( �{� COMMENTS/CONDITIONS 15 l /7-\m �0„ kso v-p*iL *fl \ - ors 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 -.---.. 9)1( (e2 (0 (104(1 ebt5ke THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 ��JIENY$ °`'� ��a 1050SR & 1050SR-HW 61 C4STLE ROCK.V1 3 95 N o D A z 62" fl — as' H o V TOP VIEW I I g D I Li 5 0 X S.. o cs, 0 N IMO18" 24" 1 1 T 011162,, = 0 4" L L _t.L —J 1 3., 141AST1c 24' ORENCO TAN( ADAPTERS 4' CAST-A-SEAL GASKET _+ l • 4' PVC BAFFLE 4" 4" I FLOOD CAP. 64" FLOOD CAP. 816 GALS. T 417 GALS. 5 1 54" 29' i rr 2- 1 /2" -- d H t 3., APPROX. WEIGHT 9,000 LBS. New 3 bedroom home 4 k h 16:3. I 1500 gal 2 compartment I Traffic rated tank / zoeller waste mate#295 220v pump in second compartment d Double Incased waterline )''' I:— —^T------- \-- — ____ -.-___ . —18' / N N I N / \ / > // / \ / _ :a \ I M I > 1 0 I 1 1 4Eu. 1 k Pourer pole 0 I 6' N I \ / r T \ \ / I / I / 4 1 Q // N 4 I- 4 a ) neighbors well over 50' in this location 1 7A _. .? 9, 400, Driveway -Al' "' ti T ti7 4"sleeve under driveway 41, 1iti 07 ow i I1 fit 'b s ,s 11 / i' L� �N ...IF4ICAH SRWM�HAWERION f li r LK:ENSI)DESIGNER I ������� CY' . *w.�w� :wwwwwww� •1, EXPIRES:0M1N �11�a1�� cti°ti`'° as 1. Q� Abandon Cracked Septic tank Per INAG24b-212A-0300 O � " 41/4 Asbuilt for Jeffery Tank only permit '�'' a°tip,x� SING 2015-00016 '�, parcel# 32023-41-00080 � f 1 f .1 i ivCOuI Printed from Masor runty D ew Sound Placement 105. itiV ..if 4 Hole concrete d-box Scale: 1��=30' •Gom.artment Septic tank with speed levelers 4"ASTM 3034 Transport Pik_ 60' 30 0' 15' 35'