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HomeMy WebLinkAboutSWG2026-00122 TANK ONLY - SWG Application / Design - 4/23/2026 MASON COUNTY 415 N 6TH STREET,SHELTON,97 ,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: SWG2026-00122 OWNER KLOEPFER KATJA SANDRA ISABEL Phone: Address: 3100 E STATE ROUTE 106 UNION, WA 98592 APPLICANT KLOEPFER KATJA SANDRA ISABEL Phone: Address: 3100 E STATE ROUTE 106 UNION, WA 98592 SEPTIC INSTALLER WILLIAM SIMMONS* Phone: 360-490-2037 Address: 51 E ANDREW DRIVE UNION,WA 98592 Site Address: 3100 E State Route 106 Primary Parcel Number: 321063400050 Permit Description: Tank only replacement Permit Submitted Date: 04/23/2026 Permit Issued Date: 04/30/2026 Issued By: Jeff Wilmoth Current Permit Fees Paid: $275.00 (additional fees may be required upon installation of system). Permit Expiration Date: 04/23/2029 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Septic Tank Only Surfacing Sewage? No Existing Failure? No Shoreline? Yes Horizontal Setbacks Met? Yes Number of Bedrooms: 3 Drinking Water Source: Private Well/Spring Additional Details: Permit Conditions: 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. I Approval of this septic permit does not approve the building location. Building location is subject to approval from all applicable departments and regulations. 2 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained • 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. OFFICIAL USE ONLY MASON COUNTY DATE RECEIVED: L /^ ^ /� A C N COMMUNITY SERVICES AMOUNT ECEIVED: W m RECEIVED BY: N Public Health(Community Health/Environmental Health) < N 360-027-9670,ext 400 or 360-275-4467,ext.400 �� �I(�Y' 415 N.6th Street-Shelton,WA 98584 _ (_:;:) O O Z Cl) ON-SITE SEWAGE TANK ONLY APPLICATION rn n APPLICANT rn j � r PHONE Z c MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE rn SITE ADDRESS-STREET,CITY,ZIP CODE APR 23 2026 I AJ NAME OF DESIGNER PHONE NAME OF INSTALLER .� PHONE (,-it Gt _v rr �`r ran �f �ti ovu' 36 O`-L1 q o -Q3 ? TYPE OF WORK(select one) DRINKING WATER SOURCE I ❑ NEW CONSTRUCTION/UPGRADES j REPAIR/REPLACEMENT PRIVATE INDIVIDUAL WELL O PRIVATE TWO-PARTY WELL z I COMPONENT(S)TO BE REPLACED/INSTALLED ❑ PUBLIC WATER SYSTEM xSEPTIC TANK ❑ PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE I ❑ OTHER H/6 A-G & ' W vV OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r I ❑ SURFACING SEWAGE O EXISTING FAILURE ❑SHORELINE ❑ 100FT+PUBLIC/COMMUNITY WELLS C) SUBMITTALS O 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS I ❑ PLOT PLAN(REQUIRED) ❑TANK CROSS SECTION(REQUIRED) O 10FT+DRINKING WATER SUPPLY LINES ❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) ❑ 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST O I ❑ PROPERTY LINES AND EASEMENTS ❑ EXISTING/PROPOSED STRUCTURES ❑ EXISTING/PROPOSED OSS COMPONENTS AND LINES -i ❑ WELLS WITHIN 100FT ❑ WATER SUPPLY LINES ❑ DRIVEWAYS/PARKING O SURFACE WATERS,STREAMS,RIVERS,ETC... I v ❑ DIRECTION OF SLOPE/CONTOURS O PERIMETER/CURTAIN DRAINS O NORTH ARROW O SCALE BAR I JJ DIRECTIONS TO SITE AND SITE CONDITIONS:(ex,locked gate) O vL jc≤S 'ieP-e c' E f-` - -,�rL zrt ' 0 V-C ©!d s � / e �,t,.docz w � ;,T ' �y���� - / ,/'6 -' __ étt r -f' a-. 2 s'O zi ' p, SJD C" iw 4 OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT D©TPER: rr^I "'.`�- i c.,-.l l,c't'� 11(1 e, COMMENTS/CONDITIONS APR 3 0 2[ MASON COUNTY ENVIRONMENTAL HEALTH SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS". TANKS MUST MEET CURF1IftIIMUM 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 �APP4LIATION APPROVED/ISSUED BY DATE V-V3 Z'7 (74 *v ) ?-3v DØ THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 HAGERMAN PRE-CAST Bob&Anita Hagerman PO Box 2842 Poulsbo WA 98370 360-598-6121/360-509-3702 PAGE: 4. -----' - - ._ , ,/ 2,50015.MAX.WHEEL LOAD AT WORST CASE LOCATION (16,000 I( FOR'-T'MODELS) 104`(8'-8'( G2 314' - I— ____ HAGERMAN PRE-CAST GFINALRA E _8" co 9 TANK MODEL: 1250 X-X DATE MANUFACTURED:J z MAX.DEPTH OF COVER: 3 FE, LIQUID CAPACITY: •1261 GAL. 3 r F 1YA (j" ( 2 5 rn 36'MAX. ThICK R T'TOP OF QC� yCj�O Y Q. WALL,T - bj O O YP DE(­ 11 1,0.TAG(LOCATE DETAIL L77 = TAG INSIDE:RISER.OR a1 r N ACCESS OPENING) ��I ' 0 ��004BBOB„LAS a `rSIONAL ET�G. •, -�.V---- 4'DIA.PASS-THRU CAPACITIES(GAL.) ACCESS AND RISERS NOTES CENTERED IN WALL OPERATING 482 4 CAST-A-SEAL GASKET M } I�— o Oo I ('5'MODEL ONLY) N ED Z Z TOTA1.((FLOOD) 557 OR F:OUIV.WATER-TIGHT 1)MINIMUM.ONE 18.0 ACCESS OPENING PER COMPARTMENT. N in CONNECTION AT EACHCO ID THE DISTANCE:BETWEEN ACCESS OPENINGS IS NOT 70 W EXCEED 10-0"CENTER TO CENTER. SD y TANK PERFORATION,1W. h1 2)RISERS MUST BE A MINIMUM OF 23'INSIDE DIAMETER. Uj . .s;� 7 F Q Q 3)RISER-TO-TANK AND R15ER-TO-ADDITIONAL SECTIONS or CD O 5000 psi CONRETE _ RISER CONNECTIONS MUST INCORPORATE JOINT GROOVES Z h N WALLS,FLOOR.AND p OR ADAPTERS TO PREVENT LATERAL MOVEMENT AND a LID,TYP. -� C-') c- CAPACITIES(GAL:) 1- PJ:MAIN WATERTIGHT. CD n 4)ACCESS AND RISER OPENINGS MUST BE COVERED WITI I A C LO,p �p v OPERATING 779 O LOCKABLE LID OR OTHER SECURED LID. Z Oc?Q TOTAL!FLOOD) 89B 29 1/2' 5)ACCESS RISERS AND LOS MUST BE STRUCTURALLY SOUND --I In TO WITHSTAND ANTICIPATED$RE-SPECIFIC LOADS. -< 'NOTE:CAPACITIES ARf APPROX.3 3/8'THICK ESTIMATES BASED ON A now) Z O ro 1 W AT BOTTOM OF WALL METER TEST PERFORMED BY c l`FC HAGERIv1AN PRE-CAST. • SEALS AND GASKETS NOTES ® ^� Q �° z (S.,) 1)SEALS AND GASKETS FOR INLET,OUTLET,AND S 7 CID INTERCOMPARTMENTAL FITTINGS MUST BE RESILIENT, m ' A 1/2'THICK 5000 P51_ 2�2 TAPER //// Z WATERTIGHT,CORR051ON•RtSISTANT,AND FLEXIBLE. CONCRETE FLOOR 4' / STONE-FREE NATIVE SOIL .Y 2)SEALS MEETINGS A57M C-I G44 OR EQUIVALENT MUST BE VOCAL - (3°THICK MIN OR COMPACTED SAND Q.) USED AT TI+E TANK WIL L.TO-PVC PIPING INTERFACE 10 I-' PREVENT LEAKAGE. S OVER STONY 501E D UJØLL • HIGI-t WATER TABLE AN)) INSTALLATION IN5TRUCTION5L BAFFLE NOTES TRAFFIC LOADING NOTES z < F-. ao 1)EXCAVATE TANK HOLE WITH VERTICAL WALLS TO 2 FEET LARGER THAN TANK ON ALL SIDES. BOTTOM OF I)INLETS TO SEPTIC TANI.5 MUST EXTEND AT LEAST 8'BELOW THE LIQUID LEVEL I)FOR TANK MODEL 5 1250 5 4 125O P; HOLE MUST BE FLAT,LEVEL,AND FREE OF WATER. HOLE MUST SLOPE DOWN 3"TO CENTER or TANK. 2)OUTLETS 10 SEPTIC TANKS MUST EXTEND BELOW 1 HE LIQUID LEVEL Al LEAST A)MAXIMUM WATER TABLE AT TOP OF LID (9 O) 2)INSTALL G'MINIMUM OF 2°MINUS MATERIAL OR SAND ON 130TTOM OF EXCAVATED HOLE. 30%BUT NOT MORE THAN-40%. B)MAXIMUM TRAFFIC LOADING NOT TO EXCEED 2.500 IS M 3)INSTALL TANK.IN CENTER OF HOLE,KEEPING MINIMUM I FOOT VOID SPACE ON ALL SIDES. 3)INLET AND OUTLET DEVICES MUST HAVE A MIN MUM INSIDE DIAMETER OF 4" CONCENTRATED LOAD X M 4)INSTALL REST OP SYSTEM,AND AFFIX RISERS AS REQUIRED BY LOCAL JURISDICTION. AND BE CONSTRUCTED OF PVC OR ADS CONFORMING 10 OR EXCEEDING THE 2)FOR TANK MODELS 1250 O•T 1 1250 P•T: 5)UPON APPROVAL TO BACKFILL,FILL VOID SPACE AROUND TANK WITH COMPACT GRANULAR(SANDY)5011 STANDARDS OP ASTM D 3034 OR ASTM D 2680,RE5PCCTIVELY. A)WATER TABLE AT GROUND LEVEL Z a co FREE OF LARGE.CLUMPS OF CLAY AND ROCKS OVER 2 INCHES IN DIAMETER. BACKFILL CAREFULLY AND 4)INLETS AND OUTLETS MAY BE MOVED FROM THE LOCATIONS SHOWN PROVIDED 5)MAXIMUM TRAFFIC LOADING NOT TO EXCEED i G,000 LB Z EVENLY IN I B'UFTS. MAXIMUM SOIL COVER IS 3G. TH_HEIGHTS ARC NOT CHANGED AND THE PIPE CENTERS ARE LOCATED AT LEAST CONCENTRATED LOADS AT 14'INTERVALS(11520 RATING) LJJ d G)IF REQUIRED,WATER TESTING TO BE DONE BY LOCAL JURISDICTION OR DOH SPECIFICATIONS. 8'FROM ANY EDGE AND AT LEAST 4'FROM ANY RERAN. 3)TRAFFIC RATED RISERS MUST MELT OR EXCEED THE d 0 7)FINAL GRADE THE SURFACE TO AVOID CHANCLLING SIIRFACE WATER TOWARDS TANK. STANDARDS OP A5TM C478(12)AND NSDOT STANDARD Q. PLAN 5-30.90.00.5-30.90.00. FRAME AND COVER MUST MEET OP. EXCEED THE STANDARDS OF A5TM A45 CL35B. 7 (2Le ykLL 4't}tF. t $ •�} `E�tloH 4 e "r`.fl A / Vtutotl Pip ? cax"R6 c rAJA--KA oo y MASON COUNTY ( ..jpARK L _________ gU[L�t IV fl - . - . ,N 500' OF S 560' OF GOVT LOT 5 EX R/ ' 32106 34 00050 I 'irRo 1 I' I '• 1 pu�1 Fo+2. I 8n 11° GOVCR� X12 1�!JE I I to t wcG gCzE , �-►c�tf�f00� - - - _-- -- - I 1 I - V N I Tr L6t r--- _ -- .� h Ic?CSTC� _ Z tom • DRAW 7 wAcw 30„H1" �ocsc-c i rn z stt moo[t1O&)9" AEI T r ° 1 1 V 55 :: .V - - _._.. -- -- CONSTRUCTION.. /� r t ._ n,_.... _ F /.�_�^.y�-. ... 1� f " OU'� PORT LUDLOW •WA•98365: •�.. f[ 1 •'i ✓ru l _.- 437.9939• A1 1t1(fC#I IOCP