HomeMy WebLinkAboutSWG2025-00180 TANK ONLY - SWG Application / Design - 5/16/2025 eaMASON 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 Tank Only Permit: SWG2025-00180
OWNER WOODCOCK JENNIFER Phone: 360-581-2053
Address: 4018 N 13TH ST TACOMA, WA 98406
APPLICANT Hunter, Adam Phone: 360 753-1226
Address: 2201 93rd Ave SW Olympia, WA 98512
SEPTIC INSTALLER JOHN KING SR* Phone: 360-878-0060
Address: 343 E Meyer Lake Dr SHELTON, WA 98584
SEPTIC DESIGNER ADAM HUNTER* Phone: 360-753-1226
Address: PO Box 162 OLYMPIA, WA 98507
Site Address: 25540 N US HIGHWAY 101
Primary Parcel Number: 422015200004
Permit Description: ATU TO MEET TLB AND RESERVE AREA
Permit Submitted Date: 05/16/2025
Permit Issued Date: 10/02/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/16/2028 (based on date of inspection)
Type of Work Other
Components being Replaced: Other
Surfacing Sewage? No Existing Failure? No
Shoreline? Yes Horizontal Setbacks Met? Yes
Number of Bedrooms: 1 Drinking Water Source: Public Water System
Additional Details: Nuwater BNR500
Permit Conditions:
4 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.
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
5 Installer to use traffic rated, coated cement tank during install and meet 10ft setback to
waterline and 50ft setback to bulkhead.
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.
OFFICIAL USE ONLY °r).-)
MASON COUNTY DATE RECEIVED: '6 _ O�_ R d
0117.., COMMUNITY SERVICES AMOUNT ^E ' ^ED BY co N
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360 427-9670,ext.400 a 360-275 4467,ext.400 SWG
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ON-SITE SEWAGE TANK ONLY APPLICATION n D
APPLICANT PHONE rn rn
BOB WOODCOCK 36058120 f� z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 1 7 !?(f ,[tug" C
4018 N 13TH ST, TACOMA, WA 98406 j `� v[ [1S m
73
SITE ADDRESS-STREET,CITY,ZIP CODEii OCTO 2�25
25540 N HWY 101, HOODSPORT, WA 98548 11
NAME OF DESIGNER PHONE By I
ADAM HUNTER 360753
NAME OF INSTALLER PHONE v IQ
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JOHN KING SR 3608780060 <
TYPE OF WORK(select one) DRINKING WATER SOURCE N
❑ NEW CONSTRUCTION/UPGRADES ID REPAIR/REPLACEMENT El PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z
COMPONENT(S)TO BE REPLACED/INSTALLED El PUBLIC WATER SYSTEM I
❑ SEPTIC TANK (El PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE 101
❑ OTHER NUWATER BNR500 ATU TANK 1 0.16 W QQ 5
I�V OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r
❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE CI 100FT+PUBLIC/COMMUNITY WELLS 6 I
I
SUBMITTALS
❑� 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
❑ PLOT PLAN(REQUIRED) ®TANK CROSS SECTION(REQUIRED) I] 10FT+DRINKING WATER SUPPLY LINES
ElPUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 0 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS 0
PLOT PLAN CHECKLIST r I O
m PROPERTY LINES AND EASEMENTS ® EXISTING/PROPOSED STRUCTURES ❑e EXISTING/PROPOSED OSS COMPONENTS AND LINES —4
❑ WELLS WITHIN 100FT le WATER SUPPLY LINES Ili DRIVEWAYS/PARKING El SURFACE WATERS,STREAMS,RIVERS,ETC... I SI
❑ DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS II NORTH ARROW 0 SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex locked gate)
HWY 101 NORTH TO SHARED DRIVE ON THE RIGHT TO SITE ON THE RIGHT.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER
COMMENTS/CONDITIONS
4scat d.0 cs(1- , „ad__ IN( .N.\),„[-Alsive_s-Do
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
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
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