HomeMy WebLinkAboutSWG2025-00369 TANK ONLY - SWG Application / Design - 9/12/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
A .:
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: SWG2025-00369
APPLICANT Hunter, Adam Phone: 360 753-1226
Address: 2201 93rd Ave SW Olympia, WA 98512
OWNER HOLLIDAY AKA BEAUDRY SUSAN A Phone:
Address: 2620 E SAINT ANDREWS DR SHELTON, WA 98584
SEPTIC DESIGNER ADAM HUNTER* Phone: 360-753-1226
Address: PO Box 162 OLYMPIA, WA 98507
SEPTIC INSTALLER GENE BOND* Phone: 360-790-8089
Address: PO BOX 14151 TUMWATER, WA 98511
Site Address: 2620 E ST ANDREWS DR NORTH
Primary Parcel Number: 321225000139
Septic pump tank placement due to plumbing in the house being
Permit Description: lower than tank inlet
Permit Submitted Date: 09/12/2025
Permit Issued Date: 09/15/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 09/12/2028 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Pump Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? Yes Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Public Water System
Additional Details: Add 2 comp. septic tank with pump in 2nd comp.
Permit Conditions:
2 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
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.
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:
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COMMUNITY SERVICES AMOUNT RECEIVED: RECEIVED BY:
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Public Health(Community Health/Environmental Health) C w
360-427-9670,ext.400 or 360-275-4467,ext.400 (n O
415 N.6th Street•Shelton,WA 98584 S V\!G a('�)5 ()o !/^A Z 70
ON-SITE SEWAGE TANK ONLY APPLICATION
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APPLICANT PHONE ITI
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JANINE BEAUDRY 3602925515 r� �� f z
MAILING ADDRESS-STREET.CITY,STATE,ZIP CODE g
2620 E ST ANDREWS DR, SHELTON, WA 98584 11 03
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SITE ADDRESS-STREET,CITY,ZIP CODE 0 ...k •'
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2620 EST ANDREWS DR, SHELTON, WA 98584 ('��� N
NAME OF DESIGNER PHONE I— 1 '-- I N
ADAM HUNTER 3607531226
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NAME OF INSTALLER PHONE
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SOUND SEPTIC r� e 1 m <� O
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TYPE OF WORK(select one) DRINKING WATER SOURCE O Cx)
❑ NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z
0 PUBLIC WATER SYSTEM LAKE LIMERICK
COMPONENT(S)TO BE REPLACED/INSTALLED 1
❑ SEPTIC TANK 0 PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE
❑ OTHER 2 0,53 W
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST
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❑ SURFACING SEWAGE ❑� EXISTING FAILURE ❑� SHORELINE 0 100FT+PUBLIC/COMMUNITY WELLS n I I
SUBMITTALS
50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
0 PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) ❑' 10FT+DRINKING WATER SUPPLY LINES
O PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 0 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST O I
O PROPERTY LINES AND EASEMENTS El EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES I
O WELLS WITHIN 100FT 0 WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC...
O DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
MASON LAKE RD TO A LEFT ON E ST ANDREWS DR TO SITE ON THE LEFT JUST PAST
THE LAKE.
OFFICIAL USE ONLY BELOWTHIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER:
COMMENTS I CONDITIONS
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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
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
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