HomeMy WebLinkAboutSWG2025-00368 - SWG Application / Design - 9/11/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
J L SHELTON:360-427-9670,EXT 400
BELFAIR:360-2754467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2025-00368
OWNER SARVER TRUSTEES GARY L& Phone:
ELIZABETH A
Address: P 0 BOX 64 LILLIWAUP, WA 98555
APPLICANT SARVER TRUSTEES GARY L& Phone:
ELIZABETH A
Address: P 0 BOX 64 LILLIWAUP, WA 98555
SEPTIC DESIGNER MICAH HALVERSON* Phone: 360-490-6365
Address: PO BOX 1519 SHELTON, WA 98584
SEPTIC INSTALLER MICAH HALVERSON** Phone: 406-490-1549
Address: PO BOX 698 ELMA, WA 98541
Site Address: 33052 N US HIGHWAY 101
Primary Parcel Number: 323105001003
Permit Description: North Glendon pod repair
Permit Submitted Date: 09/11/2025
Permit Issued Date: 09/11/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 09/11/2026 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Other
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Private Well/Spring
Additional Details:
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.
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
4 APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.gov/health/environmental/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
J L MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
rn Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
5 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.
OFFICIAL USE ONLY
DATE RECEIVED:
MASON COUNTY O - II - ug6 cn
cn
In 0 COMMUNITY SERVICES AMOUNT RECEIVED:iill��JJ 1.z/O RECEIVED BY c�''pp JJ�` W (1)
v m
— Cn
Public Health(Community Health/Environmental Health) S /A��1/^� '`l �\\ 2 - C cn
415 N. th 70,Street
ext.l-400clt o3 W ext.400 Y Y G a�96 O( J 4� Q N
41 S N.6th Street-Shelton,WA 98584 _
Z di
ON-SITE SEWAGE TANK ONLY APPLICATION 3 z
APPLICANT PHONE rn rn
C _:_:r W
Gary Sarver 253-217-8775 m z
-1 c
MAILING ADDRESS-STREET.CITY,STATE,ZIP CODE ' N O Z
PO Box 64, Lilliwaup, WA 98555 Lam=") Z m
SITE ADDRESS-STREET,CITY,ZIP CODE ELA - m
33052 N HWY 101, LILLIWAUP 98555 1 n co
-1
NAME OF DESIGNER n Jul c ) PHONE I N
Micah Halverson L___.I �, 360-490-6365 -1
r c�
NAME OF INSTALLER --- CO PHONE v I W
Olympic Construction Ilc < 1 —'
TYPE OF WORK(select one) DRINKING WATER SOURCE ON
❑ NEW CONSTRUCTION/UPGRADES ® REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z I O
COMPONENT(S)TO BE REPLACED/INSTALLED 0 PUBLIC WATER SYSTEM 1
❑ SEPTIC TANK ❑ PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE 101
® OTHER Sand Media replacement Glendon Bio-filter 2 .65ac co
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST Q
Il SURFACING SEWAGE 0 EXISTING FAILURE IN SHORELINE gi 100FT+PUBLIC/COMMUNITY WELLS n t
O
SUBMITTALS ® 50FT+PRIVATE WELLS,SURFACE WATERS.STREAMS.RIVERS
❑� PLOT PLAN(REQUIRED) I I TANK CROSS SECTION(REQUIRED) III 1OFT+DRINKING WATER SUPPLY LINES
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) III) 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS.FOOTINGS
PLOT PLAN CHECKLIST CS I O
B PROPERTY LINES AND EASEMENTS ; EXISTING/PROPOSED STRUCTURES ® EXISTING/PROPOSED OSS COMPONENTS AND LINES -I
I® WELLS WITHIN 100FT ® WATER SUPPLY LINES ® DRIVEWAYS/PARKING m SURFACE WATERS.STREAMS,RIVERS,ETC.. I C
III DIRECTION OF SLOPE!CONTOURS ® PERIMETER/CURTAIN DRAINS ® NORTH ARROW in SCALE BAR W
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex locked gate) I CA.)
North on Hwy101 to site address. Driveway access just before Ayock Beach
OFFICIAL USE ONLY BELOW THIS LINE
-
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY tc
INTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER:
COMMENTS I CONDITIO S
1ioccY\ pod a r
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
fiiJ /(0 ( m 61f1( Jz
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12n/2015
IimmINIft
..o.,. . -0 CA
nU
-I fD
n
fDD
x a_
LA) CL
--I
N (D
W N
N ••
qO W
ua/0 0 o
crl
0/' O N
�1°.b 0z
0 o
s W =
-<
r
r
r*
W D
n)
Feeder pipe from Existing Glendon Manifold
o 00
a- Ui G')
fD U'1 N.)m 0
'a
X 0
C rt cn
v
CI w Q 0
o_ K 0
CD _ -0 NJ
-< Q, fD
C) p). (/)
�, r o L� D
� `� o fD
•
CD CD N IS
a
3 co .•
-
C — —. •
3 - -n V)
1 HD
13 = � �
CuCr =
-IN 0_QD NJ '•
O0 i o 70 0
A D � 00 .
CD Nv)
cu
13 fD n
Cu �. Q
/ =,
n o
m °t a' ccra
X 5. fD o
` ` CC Z m
ET
CD
liii
= C O 00 o o
m
IVi ,- _47,77. a) Di cs'
�� a
-I-
2
0
0LA TO
r
, . • '5 O" (AIQ -47 A
' - --ti A g • .
..i
r Cii 9-
0 -5
..... i .17-- ...4
- .....„224Z______
1 0 c.
(1) 0
c....i„, 5, ......-1 , , .
--5.
P\crx.s.s ••o(A A if
• ; 1:4 d.
r' ')...: •
, .... i 0,
,
........., >,.
,
,
, .
,_ .., • v , ., , ,... . 0 ,........ , •
.,, ,..... • ,,, ...... ,.... (:),... ,.. ,......0 ., ,,,,,, .....,. b.:: 4 i
Qj—7.-YtiiitAF •-. .; Lo I --fn 611 ,-.1 I '71 •
1, • (j1 - Lt- 3-- lit fir I
) 14 i t ----• / .) 1 ' ---- "Llri
- P- - it ----'
4 -
.S\ t_, (5) ••5'
• ("\.-- 1Z7- (71 .P V . • 'Po -- --5 0
- p-o (A. ......., ....-
-- --- _..--
.. .. • i, a ci—
_- P 0.-- (\ ,S •- • .._ --)_1- 5- ii.
tii 3 6— a 1
0 -t' 2k • i - c •
(OEG-,---,
n _film u--
0 li
..., •
0 r .• ()
...--- .
•
X.. . .
• ic-----(A 4. ..0
4, --1.---4
1•:.,..-;:,?:•....,;.,...: •••.'.;:-...---'!10,// • ' ..'"
1i„\.: ;:.:- i..-'...-1:::,
( \f\ci' - , : - •.\\ I ...... : .-. .,... . .- ,. ,- '00 c,• ,,, •:::-.. ,. ,.,,.'„....1/I, . ., •
/ .
• l':-..' -:. ....,'.....-'s., • 6\- / ..'
/ .
• I:'1,....%--. - : -."r %/L.,-...b.-",bh..
/
I;-; :•-, :••••• - - ...-. (J-3 -, .
; . • . . . ..• • , ‘: ..s.:
r • --- ..' , •
. „
, i ' 7 .•- •.:, "(:). .. ....• 0 8
... .. .. .
• . % , ._ .
•
.5110 s, • s .
‘ q°131r4t3 1 4. A 1 • • • N • tt. //, ./.
7' et - • a
1 i 1-4. ..-1:4'.i • , ': - . , .s.... -: ,, -,. ... ...r/„1, /,• . ••
'1/4 , •. :: .V•t/ I/ •• .. ..' co
154 t-•-• 1 ,tr, I ;:.,'‘s. •vi •z......;...., : ., .,.1 ,-., _ •• / ,. . 9_5_
• b cl',, S-',-;:,.1
t
•
. ,..., .. • • . ,
• , .
. .. 6N
> -0 .• 1 - - • 6
..4'
• c--) 1 - : _- ,„
.. .
C '''i • , • •• :
CA) 13 / . • '
i
rn I ' .''' • , •-.1...• C/' '
73 .7. X! 1 • ....." - X :%-. -
rn — • • •• s.:.'-'2 t . 1,)
---i — 0
cp i' • •,•• '' • ". • .• .- 3
(.-ri I'• •. •:. ' • ..
)).• M
r-- !. • i '-.^. :vs°. -.••Nr.'' ..• , 0
0 ...
A '
'1..'' . • : .: : '•••• ‘ '. - / •• . • -' •'••• ..9
• •
Printed From Mason County DMS 0----
Printed from Mason County DMS -,