HomeMy WebLinkAboutSWG2024-00244 - SWG Application / Design - 6/3/2025 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2024-00244
APPLICANT MORRISON WILLIAM JAMES & MARCIA Phone: 206-849-2294
Address: 51 E PIRATES DRIVE GRAPEVIEW, WA 98546
OWNER MORRISON WILLIAM JAMES & MARCIA Phone: 206 849 2294
Address: 51 E PIRATES DRIVE GRAPEVIEW, WA 98546
SEPTIC DESIGNER CINDY WAITE-Septic Designer Phone: 360-701-0205
Address: 80 E PICKERING LANE SHELTON, WA 98584
Site Address: XXX E Lombard Rd South
Primary Parcel Number: 1 21 074401 01 0
Permit Description: 3-bedroom pressure system
Permit Submitted Date: 06/03/2024
Permit Issued Date: 06/24/2024
Issued By: David Anderson
Current Permit Fees Paid: $805.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/06/2027 (based on date of inspection)
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
3 Drain field installation not to exceed designed upslope and downslope depth specified on
design form.
4 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
5 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
6 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
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 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.
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AS-BUILT FORM - PAGE ONE R•":'•° 12/14/94
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PARCEL IDENTIFICATION I
Applibant's Name I [lci 9Y5t i
1 permit Number SWG9c - O c ) Subdivision b OftL1e 6��? ,co s 341 I
II _ (Name/ ivisicfl s Eck/Lott
Installer's NameP Assessor's Parcel No. �a�i_>ir � p
II Designer's Name g-i-n6'i � Q gl rr)) II
1!
INSTALLER CHECKLIST ll
i
N/A Yes Prior to E
I. SEPTIC TANK Completion I
Al >5 ft from foundation? --- li
B) Bldg stubout to septic tank: cleanout if not 1-2t? ^ I
I C) Baffles intact and clean? — — a
D) Dividing wall intact? -
II. D-BOX Leveled with water and/or speed leveler (circle)? j
III. DRAINFIELD �( II
A) >10 ft from foundation and >5 ft from property lines? _ li_ _
B) Laterals level to tl inch & end caps present if not looped? _ I�
C) System dimensions the same as shown on the design? U
D) Gravel clean, properly sized, and proper depth? Q
E) PRESSURE SYSTEM �/
1) Sand quality ASTM C-33? _X_ i 11
2) Head height uniform and :24 inches?
3) Cleanouts and observation ports present? X_ — d
4) Mound: Side slope 3:1? X — N
5) Owner informed electrical connections must be made by
owner or licensed electrician and inspected by DLI? _ .-_ N
IV. POTABLE WATER LINES I
A) >loft from drainfield? _ —
B) Wells >l00ft from drainfield? -- i)
V. PUMP/PUMP CHAMBER
A) Designed p used, or specs attached for equivalent pump? }( N
B) Screen •-s e •r effluent filter (circle one) installed? __ 0
C) i uscall-d for access? --
D) Alarm installed? — _ — _i
—a
I CERTIFICATION OF INSTALLATION I
1 Inst*llor, Check box from Row 'A,' check box from Row 0B," sign end date the certification.
A.IAS I certify that I installed the system 0 I certify that ell deviations from
without any deviation from the design the design stamped ■APPROVgD■ by mamas are N
stamped 'APPROVED" by MCDlis. shown on the reverse side of this form. II
N B. 11
I certify that I contacted the ,' I did not contact the designer prior i
Idesigner and left the system open for to final cover because the designer b
0 inspection up to 48 hra prior to cover. waived the notification requirement. 1`
iI further certify that all information contained on this form is accurate_ I understand
that if the information contained:herein' is not a #5 ate.' there.will-be lust.cau$e for•. .
immediate suspension of my ins ler certificat
1 44<ei. , -�_r ,/ S 95
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1 The undersigned approve: • is ins -11=1, ion of behalf of Mason oun Department of Health il
�I Services. r t 5 v ,/,
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47; Prnntea from Mason Coip '`'
AS-BUILT FORM - PAGE TWO Revised 12/14/14
il PARCEL IDENTIFICATION 1
iI
II
Appli$ant's Name / / II
/6,7 . $�7i!,
11 Permit Number swG9 d$a I Subdivision 11t �s Ue �'
II /�, { pone :/.v�ji /l�o:�/ [�ocKJ�,oC it
u Installer's Name 1�) 1( > Assessor's Parcel No. /o< �t�7 r J r 110c26 l
(rw v -light Numn.er} i4
a Designer's Name rnh/C/ GJ�2Q1
N —
1
uAS-BUILT DRAWING a
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11 - 11
11 I
11 1
11 11 1
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11 H
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CAUriag, Moor adjustment.' to septic tank location and dralnfield orientation made in the field by the installer are generally ac-
ceptable to both the department and the designer, but could in certain cases cosprosise the viability of the system. It is the
installer's responsibility to obtain prior written approval from either the health depar't•ent or the designer before asking any
deviations from the design that affect system viability. Any deviations from the approved design must be shown above.
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AS-BUILTGHECXLIST 4� H
11
1 U Drainfield orientation 0 Observation port location t_J Undisturbed native soil N
11 and layout r--i between trenches
11
11 _ u Cleanout location 1`
II ur� W
Trench/bed dimensions and � � North arrow
h critical distances within U Manifold placement 6
U Scale of drawing shown I
H layout L_1 orifice placement on scale bar li
111� U D-Box/eT"/"L" location
U Lateral placement, with Additional Mound Information 1
g '--1 septic tank/pump chamber distances to edge of bed r--i
11 location r— u Endslope width
III
b r—t u Location of wells, roads 0
u Location of buildings Overall fill dimensions 11
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ON-SITE SEWAGE TANK ONLY APPLICATION 1.
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APPLICANT m 0
PIIUNE in
WILLIAM MORRISON 206-849-2294 z
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WAILING ADDRFSS•STREET CITY S'AIE ZIP CODE 3
51 E PIRATES DR. GRAPEVIEW,WA. 98546 Co
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SITE ADDWE SS•STREET CITY ZIP CCCE 7.
260 E LOMBARD RD S, GRAPEVIEW. WA. 98546 I —'
NAME OI•DESIGNER PHONE I N
CINDY WAITE 360-701-0205
NAME OF AS TALLER PHONE +L
SELF
IYPE OF V.CIRK;Satrt;ory; DRINKING WATER SOURCE N I cp
0 NEW CONSTRUCTION/UPGRADES EPAIR REPLACEMENT .��.(�/PRIVATE INDIVIDUAL WELL ❑ PRIVATE TM-PARTY WELL 2
COMPONENT TO BE REPLACED(INSTALLED LI PUBLIC WATER SYSTEM ( y
1
`LLSEPTIC TANK PUMP TANK CI RV HOLDING TANK HECRDOIA& I OT SI?E 14'
O OTHER 0 _
t CO ,C ...1OTHER CETA LS rsa�clanlnae InYkYI TANK($I SETBACK ChECKLIST
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❑ SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINE • 100FT-t PUBLIC:COI.IMUNTY WELLS C'7 1
SUBIUITTALS 1 • SOFT.PRIVATE WELLS.SURFACE WATERS,STREAMS.RIVERS I Q
• PLOT PLAN(REOUIREDI 0 TANK CROSS SECTION(REQUIRED) El IOFT•DRINKING WATER SUPPLY LINES I
• PUMP DETAILS(IF APPLICABLE) 0 WAIVER(5}OF APPLICABLE} • SPT.PROPERTY!EASEMENT LINES,FOUNDATIONS.FOOTINGS 11
PLOT PLAN ChECILLIST r 1 C)
NI PROPERTY LINES AND EASEMEN TS • EXISTING'PROPOSED STRUCTURES • EXISTIN�r PROPOSED OSS COMPO NEWTS AND LINES O +
❑ WELLS WITNIN 100FT • WATER SUPPLY LINES IIII DRIVEWAYS..PARKING ■ SURFACE WATERS,STREAMS,RIVERS.ETC I N
■ DIRECTION OF SLOPE)CONTOURS 0 PERIMETER]CURTAIN DRAINS ■ NORTH ARROW • SCALE BAR
Nu::TICNSTOSITEANDSITECONDITIONS ie. ,octedgarp/ CD
GO OUT HIGHWAY 3, TURN LEFT ON GRAPEVIEW LOOP, GO RIGHT ONTO
LOMBARD ROAD, DRIVEWAY IS ON THE LEFT SIDE OF LOMBARD.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE r FAILURE SOURCE kra rdpo.trig prrne31
0 VOLUNTARY O MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE Of.iPLAINT ❑OTHER
COIAMEKTSI CONDITIONS
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SEWAGE TANKS MUST BE LISTED UNDER OUH'LIST CF REG/STEREO SEWAGE TANKS' TANKS MUST MEET CURRENTM.NIMUM SRE RGQUINEW:NTS EQUIPPED WITH RISERS
AND LIDS TO SURFACE AND RICLLXIE AN EFFLUENT FILTER IIF APPLICABLE I RECORD DRA'NHG AND INSTALLATION REPORT REQUIRED FUR FINALAPPROVAL
'NSPtC TOR SIGNATURE DATE APPLICATION EAPPRATICNDATE APPLICATION APPROVED/ISSUEDBY DATE
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Printed from Mason County DMS