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HomeMy WebLinkAboutSWG2025-00356 TANK ONLY - SWG Application / Design - 9/8/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 5.•�"``kgg' Public Health & Human Services ELMA:360-482-5269,EXT 400 FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2025-00356 APPLICANT SMITH DIXIE L Phone: 360-426-5793 Address: 151 E WOODLAND DR SHELTON, WA 98584 OWNER SMITH DIXIE L Phone: 360-426-5793 Address: 151 E WOODLAND DR SHELTON, WA 98584 SEPTIC DESIGNER CINDY WAITE* Phone: 360-701-0205 Address: 80 E PICKERING LANE SHELTON, WA 98584 Site Address: 30 W TYEE PL Primary Parcel Number: 519175100044 Permit Description: Replace septic tank and D-box Permit Submitted Date: 09/08/2025 Permit Issued Date: 09/09/2025 Issued By: Rhonda Thompson Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system). Permit Expiration Date: 09/09/2026 (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: 2 Drinking Water Source: Public Water System Additional Details: Hagerman 1250 ST 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 1 Approval of this septic permit does not approve the building location. Building location is subject to approval from all applicable departments and regulations. 5 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 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 DATE RECEIVED: MASON COUNTY OCt - a ' 2 u) N .,I. COMMUNITY SERVICES AMOUNTRECEIV RECEIVEDRY- Cam,J...{/ co (n v v m 1 Public Health(Community Health/Environmental Health) L w 415 N.601 Street 4h0lt n.3 W178584 ext.400 SWG 9 C o ^Lc (n XI 415 N.6th Street,Shelton WA 98584 ,Ivy\-'[,�J 0 Z 6 ON-SITE SEWAGE TANK ONLY APPLICATION 3> m Cl APPLICANT PHONE m r DIXIE SMITH 360-463-9024 zzzz, z MAILING ADDRESS-STREET,CITY,STATE.ZIP CODE CU 151 E WOODLAND DR, SHELTON, WA. 98584 m oSITE ADDRESS-STREET,CITY,ZIP CODE tN 30 W TYEE PLACE, ELMA, WA. 1 NAME OF DESIGNER PHONE \\71 CINDY WAITE 3620-701-0205 ZJ f1 ' \ NAME OF INSTALLER PHONE !/ I (ClTBD - p' Z TYPE OF WORK(select one) DRINKING WATER SOURCE 47 O ❑ NEW CONSTRUCTION/UPGRADES ❑ REPAIR/REPLACEMENT ❑ PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PA-TY WELL Z I CI PUBLIC WATER SYSTEM LAKE ARROWHEAD COMPONENT(S)TO BE REPLACED/INSTALLED t © SEPTIC TANK ❑ PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE I Cal ❑ OTHER 2 .16 AC CO I � OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST or ❑ SURFACING SEWAGE CI EXISTING FAILURE ❑ SHORELINE NI 100FT+PUBLIC!COMMUNITY WELLS C7 I 1 T� Q SUBMITTALS II SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS Iii PLOT PLAN(REQUIRED) B TANK CROSS SECTION(REQUIRED) NI 10FT+DRINKING WATER SUPPLY LINES I Q II PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) ❑ 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST 0 I Q ® PROPERTY LINES AND EASEMENTS IN EXISTING/PROPOSED STRUCTURES 0EXISTING/PROPOSED OSS COMPONENTS AND LINES ❑ WELLS WITHIN 100FT I WATER SUPPLY LINES II DRIVEWAYS/PARKING O SURFACE WATERS,STREAMS,RIVERS.ETC... I - IIIII DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS ® NORTH ARROW IN SCALE BAR DIRECTIONS TO SITE AND SITE CONDITIONS'(ex.locked gate) GO OUT CLOQUALLUM RD, GO PAST LAKE ARROWHEAD COMMUNITY CENTER, TURN LEFT ONTO LAKE ARROWHEAD DR, TURN RIGHT ONTO THUNDERBIRD DR, TURN LEFT ONTO TYEE PLACE, PARCEL IS ON THE SIDE OF ROAD. NO STRUCTURES ON SITE, HOUSE BURNED DOWN. /'UP.r I o) I2 4Q 42_ D ` �Q OFFICIAL USE ONLY BELO THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE 0 COMPLAINT ❑OTHER: COMMENTS/CONDITIONS Vtp\ace, Scidr\.) - D--190x SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS.EQUIPPED VNTH 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 EXP RATION DATE APPLICATION APPROVED/ISSUED BY DATE ../- °I, 12 lo KA7\tifrialk. ql tin _ THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 .._ _. CI Nr LI 1$V0-38d NVVRI3OVH Z V Z `.1-S 09ZI. 'S 09ZI. SIN .NII:.301VOS :A9 OS.LAVKI 699L-L89 (09£) :XVd 899L-189 (09£) .1.-d 09 I. d 09 L. :3N01-id 40986 ViVt'oNnoao 311.1V8 L60£XOS'O'd LVEZig 1 .ONI ON1 :13NION N 0 < MOON fir,I Sln/Ile WV I :31V° % ---- . . . ' o ) (1 \ • 4 . • —.... ' • 40X4, _: . CI 1 :15 .„4 si.s 0 i ;.s.P trlim G.= —•,,,,,'"6..,: Y9 !'ib: ;..1 7ftzit: ,,v,_k :.).; 71%.. is.:t 484 : t ,...,... ..k .iice , cz.c .- . 1-. ••1•2 ' • - i E .k.4.. ..:., > "2 • W, 7 L...2.2.::ilro.,-c. i C. t PPIMPsr f li, 31 s 1, • .`s ., — m :tS , • . ,•,(..,..) 14 s v • ,a ' ':,,\N, — w• Cr 73 33 c=. cc> 0c„..- 4 . p ......i , f..., --4h I • •c ? 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