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Home My WebLink AboutSWG2026-00123 - SWG Application / Design - 4/24/2026 a OFFICIAL USE ONLY MASON COUNTY DATE RECEIVED: oq JQZ4 0) D COMMUNITY SERVICES AMOUNT RECEIVED: RECEIVED Y: 0 m 1DOVI"0llr* Public Health(Community Health/Environmental Health) C N 360-427-9670,ext 400 or 360-275-4467,ext.400 \/\I5 _ QO O T 415 N.6th Street-Shelton,=98584 z cn ON-SITE SEWAGE TANK ONLY APPLICATION 0 AP CANT HONE Rl R1 Ji r1 731 z AILING ADDRESS-STRECITY STATE, o Z(B.CODE b, VJA 9 B-3 7O //BtLll FE mSITE ADDRESS-STRE CITY,ZIII1P CODE. if � �� va �a� APR 2 2026 NAME OF DESIGNER IPHONE By IN LN OF INSTALLER HONE I s, LAC 3 )70 2% TYPE OF WORK(select one) DRINKING WATER SOURCE C I ❑ NEW CONSTRUCTION!UPGRADES REPAIR/REPLACEMENT ❑ PRIVATE INDIVIDUAL WELL O PRIVATE TWO-PARTY WELL Z COMPONENT(S)TO BE REPLACED/INSTALLED ❑ PUBLIC WATER SYSTEM I .SEPTIC TANK ❑PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE IA ❑ OTHER I OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST O o ❑ SURFACING SEWAGE ❑EXISTING FAILURE ❑SHORELINE 100FT+PUBLIC/COMMUNITY WELLS 0 SUBMITTALS ❑ 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS ;4 PLOT PLAN(REQUIRED) ATANK CROSS SECTION(REQUIRED) 10FT+DRINKING WATER SUPPLY LINES I ❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) P 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST O PROPERTY LINES AND EASEMENTS EXISTING/PROPOSED STRUCTURES 6 EXISTING/PROPOSED OSS COMPONENTS AND LINES ❑ WELLS WITHIN 100FT ❑WATER SUPPLY LINES DRIVEWAYS/PARKING O SURFACE WATERS,STREAMS,RIVERS,ETC... ❑ DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS ',NORTH ARROW SCALE BAR !! I� r cr;'\ f tl DIRECTIONS TO SITE A SITE CONDITIONS:(ex.locked gate) C'_ f_(_,r, (� MY�JL Cf}�j ..J� , 411 k�' �. ..�^'r L'"c-�—`i MPSnN�' v OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALEE ❑COMPLAINT ❑OTHER: COMMENTS/CONDITIONS to c I' o4 cj s /30c1 ' " 1/y- cc c 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 I APPLICATION EXPIRATION DATE P CATION APPROVED/ISSUED BY DATE Ll'2( -Z THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 DItrU PorLJ:qcf4 1>RI°E IJ, (1,'-'-u =•••o u."L) •L.7! c. /111,159' I� Ii D ' cii " II\ I r7iII )t � EutsnNy 4t o a p j 14 0 0 i APR 3 0 MASON COUNTY ENVIRONMENTAL HEALTH 'I ', I 'I -I \ T MASON COUNTY iE0NAIpL(iG7E5 WASHINGTON T XSI TER SIMPLE SEARCH SALES SEARCH REETSIFTER COUNTY HOME PAGE CONTACT DISCLAIMER PAYMENT CART(0) Patti McLean Mason County Assessor 411 N 5TH ST Shelton,WA 98584 Assessor Treasurer Appraisal IapSffter Parcel Parcel#: 42307-50-00043 Owner Name: BURKE,TIMOTHY 3 DOR Code: 18 - Residential -All other Addressl: JANET DAILEY Sites: 61 N POTLATCH DR NORTH Address2: PO BOX 519 Map Number: WF City,State: POULSBO WA Status: Zip: 98370 Description: LAKE CUSHMAN #2 TR 43 Comment: 2O26 Market Value 2O26 Taxable Value 2O26 Assessment Data Land. $101,245 Land $101,245 D€str€ct: 0364 Tax Distr€ct 0364! ts !Improvemen $63,020 Improvements $63,020 j!Current Use/DFL: No: - _ ---rent FL. __.... Permanent Crop: $0 I Permanent Crop: $0 ITot al $164,265LTotj $164,265j!.TotalAcres: j 0.32000 Ownership Owners Name Ownership% O >nor Type CITY OF TACOMA 0% Title Owner BURKE,TIMOTHY J 100% Owner LAKE CUSHMAN CO 0% Contract Holder Sales History Safe Date Sates Document l# Par xcise cels Entee Prscei _. . ..... .... l raptor Gra--- _ ( .._ 02/01/21 2149457 34 121-48062 ICUSHMAN INVESTMENT GROUP LLC LAKE CUSHMAN CO $0 03/24/99 1687051 - 1 199948516 GERALD&NORMA PETERS H/W I-TIMOTHY J BURKE&JANET D DAILEY $0 - -- - - ... ..... - - .... .._........._... ---- .. ..... ...t Building Permits No Building Permits Available Historical Valuation Info Year l Billed Owner Land imps permCrop Value Total a xesaatst 1Toxable 2026 I BURKE,TIMOTHY J 1 $101,245 $63,020 $0 _$164,265€ $0 $164,265 2025 BURKE,TIMOTHYJ $101,245 $11,000 $0 $112,245! $0 $112,245! 2024 4BURKETIMOTHYJ $101,245 $33,0051 $0] $134,250 $0 $134,2501 2023 I BURKE,TIMOTHY J $101,245 $33,005 $0{ $134,250' $0 $134,250' 2022 i BURKE TIMOTHY J $184,080 $33 005 C $0 $217 085 1 $0 $217,085' View Taxes . Peters Gerald J TBURSTON-M 801' AI li DISTRICT Ito. ? Y Division of Sanitation Court House Annex Court House Annex Shelton, '.lashington Olympia, I Iashington Phone 426-8515 Phone 352-4851 APPLICATION TO CONSTRUCT OR AIlPER AN INDIVIDUAL STAGE DISPOSAL SYSTEM (Application required for each installation) Property Owner Telephone s ea®e Print Nfeiling Address_ �'/ S'. /f/` A1 � /r! Address of Site, ' ;.,. rr� . ■ s. a . .■.rya Location of PYo 'petty, including: Lot ;#� $lock; .��...� Detailed directions to site: Pronexty Coanmercial! Sise Reside ce No. Bedrooms / _Basement Type__„__ .— I-later Supply: !ell Spring Other Is My water supply or body of water within 50 feet of sewage system? Yes No_ Septic Tank 4 )o Ions. Drainage stem Lextgth,'_feet. Trench %lidth t. (Refer to Table 1 of Bulletin) (Refer to Table 2 of Bulletin) And/or system other than above Check for Installation of: Automatic Laundry ( ) Automatic Dishwasher ( ) Garbage Grinder ( ) Is Contractor installing septic tank? yesV .No afield? area, no Name of Sewage Contractor _4._A4 // Sewage oontr for must belioens by Thurston-Mason Health District 1'CH PLOT PLAN AND PLANS OP PROPOSID SYSTEM ON SEPARATE SHEET OF PAPER THE RSXGN !) hereby applies for a permit to oonatruct a new ( ) and/or altar ( ) a sewage system on above pro j ace aaoe 4ttbe Bulletin. ` - AppliosntIa Signature Address Buulletin, Washington State Department of Health Bulletin S. No. 1 entitled Septic Tank System for Your Home for minimum requirements. Permit Na*7 o% l) Date Issued J_ Z.- /— Area.____ S.._._._ anitarian ______�� . — Dates Inspected _._._.._ ._._ Remarks Date Approved 7 j/'F '7 approved _ - - (Sanitarian) ' :. n V } Prntedfnm Mason County D S ; . . 5)' ?I4 -f►c. JrQi,,lPhe_ : . ..: . . Prnted From Mason County Printed from Mason County DMS N ate No. AP22LICATION FOR BUILDING PIT `% MASON COUNTY, WASHINGTON �L, /J' , J $/ Received of �� -� e �_ ---- Address &1 _ / City ikJ AS PER County Commissioners' resolution and laws of 1955, this application is to be approved or rejected by Mason County Commissioners. You will be notified by mail as to their findings. Legal Description — Section or Lot - Township or Block - Range Intended use of buildings ( 4e ; ) Type of Construction — z- -- Estimated Cost 5/)Q �Hrat Name of Contractor Labor & Industries Acct. # Address City ' Signature of Contractor or age PLOT PLAN Draw sketch with dimensions showing: (1 ) Property size (2) Ground plan of proposed buildings (3) Distance of proposed sewage disposal system to water supply, lake, stream or bay; 2`l.�4' 04V°al +4k 1r a 1a'o tear 7SacoAL L A Kid -- -- Q ( (4 yc ® /7 pz xrz 11 Recommended for sewage permit Yes ) No Gang tarisn - _.._i�, Note: Permits for all sewage disposal units are required by ordinance, and shall be inspected by a Health Distrcit Sanitarian. Additional information may be obtained at the Health Department, Shelton. fi Printed from Mason County® S INFILTRATOR® CM-1060 septic tanks Features&Benefits • Strong compression molded polypropylene construction • Lightweight,plastic construction and inboard lifting lugs allow for easy delivery and handling ° a ; gym,_ Y , Integral heavy-duty green lids that interconnect with EZsnap risers and pipe riser solutions • Structurally reinforced access ports eliminate distortion during installation and pump-outs •. Reinforced,stru'ctural ribbing and fiberglass bulkheads offer i additional strength rai Can be installed with 6"to 48"(152 to 1,219 mm)of cover° • Can be pumped dry during pump-outs • Suitable for use as aseptic tank, pump tank,,orrainwater°(non potable)tank r° • No special water filling requirements are necessary • The tank may be backfilled with suitable native soil. See installation instructions for guidance. The Infiltrator CM-1 060 is a lightweight, strong and durable septic tank. This watertight tank design is offered with Infiltrator's line of custom-fit risers and heavy-duty lids. Infiltrator compression molded tanks provide a revolutionary improvement in thermoplastic septic tank design, offering exceptional long-term strength and watertightness. Infiltrator EZsnap Riser TANK CUTAWAY System i.f Partition baffle wall HEAVY DUTY LID CUTAWAY— ii i' _ Reinforced 24"structural access port Structural bulkheads ' l MID-SEAM CUTAWAY Reinforced water tight mid-seam gasketed connection INFILTRATOR ad" water technologies CM-1060 General Specifications and Illustrations LUG RISER CONNECTION „ r a48 I LIFTING STRAP (4 TOTAL) (TYPICAL) the;CM 1 D60 is a'comprsssio'n molded`two-piece ml�f E ° P'°"" seam thermoplastic tank The CM-1 b6O,compression ° j molded design allows for a mid-seam joint that',has = precise dimensions for accepting an'engineered EPDM gasket.rr lnfiltrator's gasket design utilizes,'technology from 61.T the water industry to deliver proven means of maintaining E EXTERIOR ,a watertight seal.The two-piece design,is Perri ianently f i�fastened using axsystem of molded-in alignment dowels and.Iocking seam clips The CM 1060 is assembled and sold through a network of certified Infiltrator distributors 134.2 I3,409i EXTERIOR LENGTH TOP VIEW ____ _y_ ._ ., Must be backfilled and installed in . _ L!JSL,;kj[IRE] accordance with the Infiltrator IM-and tFIBERGLASS 024.0(610)ACCESS PORT 10.1(257)FREEBOARD CM-Series Septic Tank General WITH LOCKING LID(2) I r 04[102) Installation Instructions.For shallow OUTLET TEE ground water conditions reference INvoarnaroR 17.8%AIR SPACE .g• . the Infiltrator IM-and CM-Series Tank _ OUTLET/ IJy• Buoy anc Control Guidance. w F PER CODE[j 1L �■ • Please visit WWW.infiltratorwatercomE 17 1,IA FIBERGLASS LIQUI SUPPORT SS DEPTHor scan QR code for the latest RT (TYPICAL)information. AL) WITH BAFFLE WALL WHERE RE UIR LEI SIDEVIEW Working Capacity 1,111 gal(4,207 L) Total Capacity 1,309 gal(4,956 L) OUTLET Airspace 17.8% Length 134.2"(3,409 mm) 54.5.. Width 61.7"(1,567 mm) EXTERIOR SEAM CLIP HEIGHT Length-to-Width Ratio 2.3 to 1 (TYPICAL) Height 54.5"(1,384 mm) LIFTING STRAP (TYPICAL) Liquid Level 44"(1,118 mm) Invert Drop 3"(76 mm) END VIEW k Fiberglass Supports 2 CONTINUOUS Compartments 1 or 2 TANK TOP ELASTOMERIC HALF GASKET Maximum Burial Depth 48"(1,219 mm) TANK INTERIOR SEAM CLIP Minimum Burial Depth 6"(152 mm) INTEGRAL Maximum Pipe Diameter 4"(102 mm) ALIGNMENT TANK BOTTOM DOWEL HALF Weight 331 lbs(151 kg) ;MID HEIGHT SEAMMSECTIONc 4 Business Park Road P.O.BoOboo 8 0d Saybrook,CT 06475 860 860-577-7000•Fax 860-577-7001 1-800-221-4436 INFILTRATOR www.infiiltratorwater.com water technologies info@infiitratorwater.com U.S.Patents:8322948;8337119;8297880;7914230;7008138.Other patents pending.Infiltrator,Quick4 and EZflow are registered trademarks of Infiltrator Water Technologies.Infiltrator Water Technologies is a wholly-owned subsidiary of Advanced Drainage Systems,Inc.(ADS). 152022 Infiltrator Water Technologies,LLC.Not responsible for any typographic errors.Printed in U.S.A. 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