HomeMy WebLinkAboutSWG2026-00103 - SWG Application / Design - 4/13/2026 M p SO N COUNTY 415 N 6TH STREET,SHELTON, ,WA 98584
• � H 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: SWG2026-00103
OWNER ASHBY KATHLEEN A Phone:
Address: P O BOX 144 LILLIWAUP, WA 98555-0144
APPLICANT Hunter, Adam Phone: 360 753-1226
Address: 2201 93rd Ave SW Olympia,WA 98512
SEPTIC INSTALLER DARIN OGG* Phone: 360-790-3021
Address: PO BOX 1336 HOODSPORT, WA 98548
SEPTIC DESIGNER ADAM HUNTER* Phone: 360-753-1226
Address: PO Box 162 OLYMPIA, WA 98507
Site Address: 31 N LILLIWAUP ST
Primary Parcel Number: 323305122002
Permit Description: Septic tank replacement
Permit Submitted Date: 04/13/2026
Permit Issued Date: 04/13/2026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $275.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 04/13/2027 (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? No
Number of Bedrooms: 2 Drinking Water Source: Private Two-Party Well
Additional Details: IM-1060
Permit Conditions:
5 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
1 Approval of this septic permit does not approve the building location. Building location is
subject to approval from all applicable departments and regulations.
4 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
3 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
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.
OFFICIAL USE ONLY
MASON COUNTY DATE RECENED: 6 �3 a cs c n
COMMUNITY SERVICES AMOUNTRECE D: BY: W N
_ RECEIVED _ o m
Public Health(Community Health/Environmental Health) CA
+'�?A 360-427-9670,ext.400 or 360-275.4467,ext.400
415 N.6th Street-Shelton,WA 98584 C 1 i,( �� — 0
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ON-SITE SEWAGE TANK ONLY APPLICATION
APPLICANT PHONE m m
(-
Kathleen Ashby 4257583947 z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 9
PO BOX 144 Lilliwaup WA 98555 m
SITE ADDRESS-STREET,CITY,ZIP CODE ,�
31 North Lilliwaup Stre V 1% ,` odsport 98548 I N
NAME OF DESIGNER \ PHONE W
ADAM HUNTER �+ Q� ) 7 3607531226 I O
NAME OF INSTALLER ti PHONE
\.�.. EN.)
TYPE OF WORK(select one) c5' DRINKING WATER SOURCE I 0
0
ANEW CONSTRUCTION/UPGRADES\_8REPAIR/REPLACEMENT PRIVATE INDIVIDUAL WELL Q PRIVATE TWO-PARTY WELL Z IV
COMPONENT(S)TO BE REPLACED/INSTALLED 8 PUBLIC WATER SYSTEM I r
13 SEPTIC TANK ❑ PUMP TANK ❑RV HOLDING TANK BEDROOMS I LOT SIZE I
❑ OTHER 2 0.15 op
OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r
0 r
❑ SURFACING SEWAGE Ii EXISTING FAILURE ❑SHORELINE ® 100FT+PUBLIC/COMMUNITY WELLS 0
SUBMITTALS a 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
® PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) 13 10FT+DRINKING WATER SUPPLY LINES I
❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) 13 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST I-
0 I
13 PROPERTY LINES AND EASEMENTS 13 EXISTING/PROPOSED STRUCTURES ®EXISTING/PROPOSED OSS COMPONENTS AND LINES
® WELLS WITHIN 100FT 0 WATER SUPPLY LINES 13 DRIVEWAYS/PARKING 13 SURFACE WATERS,STREAMS,RIVERS,ETC... I
13 DIRECTION OF SLOPE/CONTOURS 13 PERIMETER/CURTAIN DRAINS 13 NORTH ARROW 13 SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
HWY 101 TO A LEFT ON LILLIWAUP RD (JUST BEFORE THE BRIDGE) TO SITE ON
THE LEFT.
OFFICIAL USE ONLY BELOWTHIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING O BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER:
COMMENTS/CONDITIONS 1 -v ' (\,( (Q
6 0'Q-eJLP - Y
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
f13/27 �1r 31,E
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
OEXISTING 2 BDRM RES NOTES:
SCALE: 1" = 30FT 2O EXISTING TWO PARTY WELL RISERS TO SURFACE REQUIRED OVER ALL TANK LIDS
• EFFLUENT FILTER REQUIRED
• TANKS TO BE ON STATE APPROVED LIST
1"
6 8 <�/ EXISTING DRIVE • TANK FAILED DUE TO AGE
EXISTING STUBOUT/CLEANOUT(I E.-99.0)
G�i 5O FAILED SEPTIC TANK(ABANDON PER CODE)
� v
7 120 7 \ N O PROPOSED 1060GAL.SEPTIC TANK(IN.EL.-98.0/OUT.EL.-97.7)
A 7 APPROXIMATE LOCATION OF EXISTING D.F.
O \ 72.8
RESERVE AREA
WATERLINE
10 RBM IS GROUND EL.@ EXISTING SEPTIC TANK(RBM=100.0) -H GASTIGHT SEAL
1 0
US
GLEANOUT
ON N'ACCESS RISE4
RS
1 '
51.3 1
FRAM SEWAGE
SOURCE (O PUMP
HAMSER
3
APPRONEDEFFLUENTF ER
50.6
157.1
9 /
63.3 /
2
CONTOUR LINES PER GEODATA,REFER TO APPLICATION FOR PROPERTY
647' ACREAGE.NAVD88 ELEVATION IS UNKOWN
®�� THIS IS NOT A SURVEY:
site features,topography,elevations and benchmarks are based on assumed datum
APR 1 provided by the owner and county planning records and are intended only for the review
3 2026 and construction of the proposed septic system design.Hunter Septic Design
MASON COUNTYEN� recommends that a licensed professional land surveyor always be used to set corners,
ENVIRONMENTAL HEALTH 13/26 establish lot lines,determine elevations and topography and/or provide a legal site plan.
RET
A fee may be charged for final inspection and record drawings
REVISION LOG:
VERSION-DATE
ADAr.i iNUNTER "
L sj3:��tls (Cj'S.1.n
HWY 101 TO A LEFT ON LILLIWAUP ST TO SITE ON THE LEFT HUNTER SEPTIC DESIGN DESIGNER:
ADAM HUNTER
NOTE:REDUCED SETBACK BETWEEN TANK AND PROPERTY LINE(2FT)JUSTIFIED AS PROPERTY LINE IS NOT DOWN GRADIENT 2201 93rd Ave SW/Olympia,WA 98507
REDUCED SETBACK BETWEEN TANK AND FOUNDATION(2.5FT)JUSTIFIED AS TANK IS DOWN GRADIENT 360-890-2778/adam@hunterse ticdesign.com SITE ADDRESS:
SEPTIC SYSTEM DESIGN FOR: 31 N LILLIWAUP ST
LILL UPS
T KATHLEEN ASHBY
SITE LEGAL:
PARCEL NUMBER: SITE/PERMIT#: PAGE:
Y 101 323305122002 1 OF 1