HomeMy WebLinkAboutSWG2025-00456 - SWG Application / Design - 12/1/2025 M : 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 Tank Only Permit: SWG2025-00456
OWNER WARICK JERRY D & RANDI L Phone:
Address: 5901 REHKLAU RD SE OLYMPIA, WA 98513
APPLICANT WARICK JERRY D &RANDI L Phone:
Address: 5901 REHKLAU RD SE OLYMPIA, WA 98513
SEPTIC DESIGNER JIM HUNTER* Phone: 360-753-1226
Address: PO BOX 162 OLYMPIA, WA 98507
Site Address: 120 W MORROWS LN
Primary Parcel Number: 520085000005
Permit Description: Add NuwaterBNR tank for new proposed home location and to add
TLN for Class A state waiver and Shoreline BLD policy
Permit Submitted Date: 12/01/2025
Permit Issued Date: 01/29/2026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $270.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 12/01/2028 (based on date of inspection)
Type of Work OSS New Construction
Components being Replaced: Other
Surfacing Sewage? No Existing Failure? No
Shoreline? Yes Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Private Well/Spring
Additional Details: Add Nuwater BNR500
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.
5 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
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.
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.
k
OFFICIAL USE ONLY
MASON COUNTY DATE RECEIVED: I / ,• f / cr5
yDCOMMUNITY SERVICES AMOUNTRECEI ED: IURECEIVEDBY: C CA
CA
f Public Health(Community Health/Environmental Health) `''� �Qo�P ��r ≤ N
360-427-9670,ext.400 or 360-275-4467,ext.400 /� y
415 N.6th Street Shelton,WA 98584 CW/ - a��5 - 00(,j5( g o
..J V O �1
Z U)
ON-SITE SEWAGE TANK ONLY APPLICATION z -s,
APPLICANT PHONE m m
JERRY WARICK 360 701-0454 <`\n\\\\� z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE V
5901 REHKLAU RD SE, OLYMPIA, WA 98513-9237 2�o c�O�' m
SITE ADDRESS-STREET,CITY,ZIP CODE U i
120 MORROWS LN, SHELTON, WA 98584 V 1171
NAME OF DESIGNER PHONENt Icl
JIM HUNTER 360-753-1226
NAME OF INSTALLER PHONE 0 v Io
IIZ
TYPE OF WORK(select one) DRINKING WATER SOURCE U) I
NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL z
lac
COMPONENT(S)TO BE REPLACED/INSTALLED o PUBLIC WATER SYSTEM I
12 SEPTIC TANK PUMP TANK ❑ RV HOLDING TANK BEDD{ . LOT SIZE I ci
O OTHER 0 / 70"..' 0.46 OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST QW IV
I
❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE 0 100FT+PUBLIC/COMMUNITY WELLS n ^
SUBM/TTALS ❑ S0FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
IQ,
JJ PLOT PLAN(REQUIRED) JiTANK CROSS SECTION(REQUIRED) 0 10FT+DRINKING WATER SUPPLY LINES I c
o PUMP DETAILS(IF APPLICABLE) Q/WAIVER(S)(IF APPLICABLE) ❑ 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT P N CHECKLIST r I cl
1
iJ PROPERTY LINES AND EASF„MENTS EXISTING/PR POSED STRUCTURES EXISTING/PROPOSED OSS COMPONENTS AND LINES
WELLS WITHIN 100FT P/ dJWATER SUPPLX.LINES DRIVEWAYS/PARKINGURFACE WATERS,STREAMS,RIVERS,ETC... I
DIRECTION OF SLOPE/CONTOURS PERIMETER/CURTAIN DRAINS %NORTH ARROW prSCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS (ex locked gate)
SHELTON MATLOCK RD, RIGHT ON W MORROWS LN TO ADDRESS ON RIGHT.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE 0 COMPLAINT O OTHER:
COMMENTS/CONDITIONS
A sIt��a-revC�n�sac� -Fay -1-14\1Ls-I-44-e_ We e-+� �(���h�t�-
a I s 0 -fr slhirehw- VH7 P°(((-7
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
X244 iz._ 8 p...jo\art,ran (iri 4
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
t
A 5 pz� , , J U �\--;I _v --1711: —
{� t
5OO 11/4,-C....). \ � � - � , _..cl' \ /� .�
�'�j ! ,\ ltd
SC- ►�.t,.�. - k 7- ° J r" i 35 \ = 'v6.4\144-1" E t.0 04 1 s j
' 1,
�c0 ', s' t ti , N
1 —'e\ 47/
;i i -z...
�'1
t
--r .
I-
le-Y' S .1.. 1 _.-2 -__T SZn _ __._C-o►��t !C1- . ca_._ r+,P . .a.: , �-E ►-,-tu- .. h1�2 T`6 "i ...C���u 'fm C_ 4 !1,��._' ?' �R ' .C o
�? ICE Cam. __ __' - � - - _�- � ti.��L ---- -- .., .__. _ .y. _ ._ _.1,-W..._._- v._._ . .....
S.--Ct-)5__o_O 14__C,‘.4.1_‘_0__-.4;_tt2Y_T__ _ . __,-17:------ --)Itv., 1.--?...-6 ti- _v-.3.t..." --- _„ ___________ .____ ____ .
i i - G �� ►�►_ _.�5s^P't;\�-_ _._ _-. _____�_____..__._ .__ _.__.,_ W,• -ta' \i �-I t 4‘r�Saw_ t_i1�ti''tic- 8+ , t- u1�-___L>s_.-%s. 0_
v c
._ t^ --E-4-c. ._..-�� -C.-_Z I.S. t Vt---- ---------- v.liC ly 5`'T.M -Ii'; \4�
4tZ _--
G ct c t,sL. Sr.k`1$D
___._ ____-..,___.r ___ _____ A FEE WILL BE CHARGED AFTER INSTALLATION FOR FINAL INSPECTION&RECORD DRAWING
—•�t,_ • , ,>rc.. raG+E, 7....-7,v, _ �"�• JIM HUNTED AND ASSOCIATES
----- - --- - - `" _ P.O.BOX 162,OLY,WA 98507 753-1226 JHANDASSOCIATES@HOTMAILCOM
,c I _... \_,._ 4- DESIGNER-JIM HUNTER
_ _� � v APPROVED SEPTIC SYSTEM DESIGN FOR-
3 'CC3 07�C t, „J< - _ - - r ,...,,,=.772,.._ it JERRY WARICK
___ _ a JAN 2 y 2026 SITE ADDR-
T �� MASON COUNTY ENVIRONMENTAL HEALTH
QV -r'�?ZQ _zJ" W ,M '( � ' 120 W MORROWS LN
- .-t',w A \S (..1....0\40.t4 - . Q- Lie T t,:)- i .i.00%.6 :12-1 .�.. J RET LEGAL OF
-____ . _ . . SITE#
/mss T 52008-50-00005
� R S L