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HomeMy WebLinkAboutSWG2025-00386 TANK ONLY - SWG Application / Design - 9/25/2025 rnt MASON COUNTY 415 N 6TH STREET, 84 SHELTON,WA 985 SHELTON:360 427-ON EXT 84 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: SWG2025-00386 APPLICANT PECK DEAN M & KARNA R Phone: Address: 914 PACIFIC AVE BREMERTON, WA 98337 OWNER PECK DEAN M & KARNA R Phone: Address: 914 PACIFIC AVE BREMERTON, WA 98337 SEPTIC DESIGNER ROD LEFT* Phone: 360-698-8488 Address: PO BOX 2954 SILVERDALE, WA 98383 Site Address: 14900 NE NORTH SHORE RD Primary Parcel Number: 322275400070 Permit Description: Drainfield remediation Permit Submitted Date: 09/25/2025 Permit Issued Date: 09/30/2025 Issued By: Rhonda Thompson Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system). Permit Expiration Date: 09/30/2026 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Other Surfacing Sewage? No Existing Failure? Yes Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 1 Drinking Water Source: Public Water System Additional Details: Existing Permit Conditions: 1 Approval of this septic permit does not approve the building location. Building location is subject to approval from all applicable departments and regulations. 3 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 4 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 5 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 2 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS. PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS. THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND/OR DESIGN APPROVED. FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES. For Final Inspection visit: masoncountywa.gov/health/environmental/onsite/oss-inspection-request.php or call: 360-427-9670, extension 400. w OFFICIAL USE ONLY MASON COUNTY DATE RECEIVED: o J n.,5` Q- to D COMMUNITY SERVICESlb Cl) AMOUNT RECEIVED: RECEIVED BY: W (/) Public Health(Community Health/Environmental Health) tti- CNP V C cn a:SN360 6hStt e+CS00v]6WA98584 exts00 SwG aoa..s - 00 3 8`(0 o x a15 V tith$tree!-Shelton.WA 98586 — Z Cl) ON-SITE SEWAGE TANK ONLY APPLICATION 3 m APPLICANT PHONE /� I- Karna Peck ' Z �jjj���h,,,,,, C MAILING ADDRESS-STREET,CITY.STATE.ZIP CODE 914 Pacific Ave, Bremerton, WA 98337 r- -• ( 4/SITE ADDRESS-STREET,CITY.ZIP CODEIf 14900 NE North Shore Rd, Tahuya, WA 98588NAME OF DESIGNER PHONENRod Left 360-698-8488NAME OF INSTALLER PHONE NTYPE OF WORK(select one) DRINKING WATER SOURCE❑ NEWCONSTRUCTION/UPGRADES IN REPAIR/REPLACEMENT ❑ PRIVATE INDIVIDUALWELL ❑ PRIVATETWO-PARv COMPONENT(S)TO BE REPLACED!INSTALLED 0 PUBLIC WATER SYSTEM Shorebrook Community Club 78600 ❑ SEPTIC TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS 1 LOT SIZE I Ul 1 ® OTHER D-Box,15'of lateral lines \ 7,405 sq ft co OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST Q ❑ SURFACING SEWAGE ®EXISTING FAILURE 0 SHORELINE 0 100FT+PUBLIC/COMMUNITY WELLS C) 1 SUBMITTALS 0 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS I O U PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) 0 10FT+DRINKING WATER SUPPLY LINES I O ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 0 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST O I O III PROPERTY LINES AND EASEMENTS • EXISTING!PROPOSED STRUCTURES •EXISTING!PROPOSED OSS COMPONENTS AND LINES -- ❑ WELLS WITHIN 100FT 111 WATER SUPPLY LINES • DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC.. I ❑ DIRECTION OF SLOPE CONTOURS 0 PERIMETER!CURTAIN DRAINS • NORTH ARROW • SCALE BAR O DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) Replace D-Box, 5' of drain field in east lateral, and 10' of drain field in west lateral Rhonda instructed us to submit this application. - - OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER: COMMENTS/CONDITIONS WATINec\fi`al‘ 1.10CIN..010- w1 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 ..."*"‘..."'-. 49t 13'0 ino (6-fulqW1 INITC- THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 . 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