HomeMy WebLinkAboutSWG2025-00451 - SWG As-Built - 11/25/2025 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,EXT400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2025-00451
OWNER CLARK BARBARA J Phone: 360-600-6179
Address: P 0 BOX 156 HOODSPORT, WA 98548
APPLICANT CLARK BARBARA J Phone: 360-600-6179
Address: P 0 BOX 156 HOODSPORT, WA 98548
SEPTIC INSTALLER DARIN OGG* Phone: 360-790-3021
Address: PO BOX 1336 HOODSPORT, WA 98548
Site Address: 141 N NORTH HILL RD
Primary Parcel Number: 422125016017
Permit Description: Replace septic tank
Permit Submitted Date: 11/21/2025
Permit Issued Date: 11/25/2025
Issued By: Rhonda Thompson
Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 11/25/2026 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 0 Drinking Water Source: Public Water System
Additional Details: Hagerman 1250 ST
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
3 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County 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.
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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
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NOVZ12025 OFFICIAL USE ONLY
' '`' . MASON CO �" RECEIVED:
COMMUNI AMOUNTfiJo3
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- Public Health(Community Health/Environmental Health) tp
360�x7-%14 ext.•0 or 3GOv5-M67.art 400
At 6th SWG 2002-5 - osi o 53
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ON-SITE SEWAGE TANK ONLY APPLICATION >z z
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MAILING ADDRESS-STREET.CITY,STATE,ZIP CODE
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SITE ADDRESS-STREET.CITY,ZIP CODE
/ (f/ A) /Udlr� iL// /oa 67 4- Ima P S 7 I
NAME OF DESIGNER PHONE
17^ (Clime I N
NAME OF INSTALLER / (�� PHONE
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TYPE OF •- (select one) DRINKING WATER SOURCE N I
0 NEW CONSTRUCTION!UPGRADES 'REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 P JVATE TWO-PARTY WELL 7.76
ICOMPONENT(S)TO BE REPLACED/INSTALLED frt\PUBLIC WATER SYSTEM t'
. SEPTIC TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS �j uhl( Wn LOTslzE
El /2 `n0( ul ) 8° X "° W I�
OTHER DETAILS(select al that apply) TARNS)SETBACK CHECKLIST 1— I 0
0 I
0 SURFACING SEWAGE 4-EXISTING FAILURE 0 SHORELINE la 100FT+PUBLIC/COMMUNITY WELLS C)
X I~
SUBMITTALS -2F SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
❑ PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) la 10FT+DRINKING WATER SUPPLY LINES
0 PUMP DETAILS(IF APPUCABL.E) 0 WAIVER(S)(IF APPLICABLE) - Y/5FT+PROPERTY/EASEMENT EASEMENT LINES,FOUNDATIONS,FOOTINGS I
PLOT PLAN CHECKLIST 0 I (
id PROPERTY LINES AND EASEMENTS la EXISTING/PROPOSED STRUCTURES 'EXISTING/PROPOSED OSS COMPONENTS AND LINES -4 /
0 WELLS WITHIN 100FT 111 WATER SUPPLY LINES ''DRIVEWAYS/PARKING fif SURFACE WATERS,STREAMS.RIVERS,ETC... I---.
a DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS IIORTH ARROW 0 SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gale) I
— — OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(t«reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER:
COMMENTS/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 ANIYINSTALLATlON 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 12/72015
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DRAFTED BY: 1 250 S, 1250 S-T,
P.O.BOX 3097 BATTLE GROUND,WA 98604 D.R N 1250 P & 1250 P-T
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DRAFTED BY: 1250 S, 1250 S-T. m
P.O.BOX 3097 BATTLE GROUND.WA 98604 D.R.N. 1250 P & 1250 P-T
PHONE: ;380) 887-7668 FAX: (360) 687-7669 SCALE: U1
NTS HAGERMAN PRE-CAST