HomeMy WebLinkAboutSWG2025-00279 - SWG Application / Design - 7/10/2025 MASONcQV.NTYL. 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: SWG2025-00279
APPLICANT B-LINE CONSTRUCTION Phone: 1.360.489.9169
Address: 2971 E PHILLIPS LAKE LOOP RD SHELTON, WA 98584
OWNER HATHAWAY ET AL DEAN Phone:
Address: 8612 HAVILAND AVE SE LAKEWOOD, WA 98498
SEPTIC INSTALLER TAYLOR TONEY* Phone: 360-489-9169
Address: 2971 E PHILLIPS LAKE RD SHELTON, WA 98584
SEPTIC DESIGNER CINDY WAITE* Phone: 360-701-0205
Address: 80 E PICKERING LANE SHELTON, WA 98584
Site Address: 261 NE MADRONA AVE
Primary Parcel Number: 322145105024
Rebuild sand filter- Remove contaminated material down to bio mat
Permit Description: and haul in new material
Permit Submitted Date: 07/10/2025
Permit Issued Date: 09/08/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 09/08/2026 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Other
Surfacing Sewage? Yes Existing Failure? No
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Public Water System
Additional Details: Rebuild sand filter
Permit Conditions:
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
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
4 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
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.
mismoisimmiw
Cindy Waite
80 E Pickering Lane
Shelton, Wa. 98584
360-701-0205
8/7/2025
RE: Parcel #32214-51-05024
261 N E Madrona Ave.
SWG2025-00279
The sandfilter on this property is failing. Sandfilter location is remaining in the same
location. Contractor is going to remove sand and 1-2" of pea gravel, install new pea
gravel, C-33 sand and backfill material. Liner, underdrains and 7-8" of pea gravel will
remain.
The existing pond water feature has been partially filled and the remaining lined. The
seasonal drainage does not run continuously from December 1 through March 31.
I have also submitted a more accurate plot map.
Respectfully submitted APPROVED
SEP 0 8 2025
Cindy Waite
MASON COUNTY ENVIRONMENTAL HEALTH
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CAUTION:Minor adjustments to septic tank location and drainfield orientation made in the field by the installer are generallyle to both the department
and the designer,but could in certain cases promise the viability of the system It is dip installer's responsibility to obtain pilot written approval from either the
health department or the designer before making any deviations from the design that affect the system viability. Any deviations from the approved design must be
shown above.
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Installer Check a box from Row"A"and"B",sign and date the certification
A. ❑ I certify that I installed the system without any A [certify that all deviations from the design stamped
deviation from the design stamped"APPROVED"by "APPROVED"by MCDHS are shown above.
MCDHS Novel - c. T...e 0 .Iv .fS.. (4)41-
B. ri,, I certify that I contacted the designer and left the O I did not contact the designer prior to final cover because the
system open for inspection up to 48 hrs prior to designer waived the notification requirement.
cover. •
I further certify that all information contained on this form is accurate. I understand that if the information contained herein is not
accurate,there will be just cause for immediate suspension of my installer certification. •
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The undersigned approves this installation on behalfeh of Mason County Department of Health Services.
Sanitarian Date
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