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Home My WebLink AboutSWG2026-00101 TANK ONLY - SWG Application / Design - 4/9/2026 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: SWG2026-00101 OWNER SULLIVAN SEAN M&DENISE Phone: Address: 770 E CEDAR ST BELFAIR,WA 98528 APPLICANT SULLIVAN SEAN M &DENISE Phone: Address: 770 E CEDAR ST BELFAIR, WA 98528 SEPTIC INSTALLER MAX WALKER* Phone: 360-620-2040 Address: PO BOX 1351 BELFAIR, WA 98528 Site Address: 770 E CEDAR ST Primary Parcel Number: 222127590032 Permit Description: ATF Pump Tank replacement Permit Submitted Date: 04/09/2026 Permit Issued Date: 06/01/2026 Issued By: Rhonda Thompson Current Permit Fees Paid: $550.00 (additional fees may be required upon installation of system). Permit Expiration Date: 04/09/2029 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Pump Tank Only Surfacing Sewage? No Existing Failure? Yes Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 3 Drinking Water Source: Public Water System Additional Details: Hagerman 1000g pump tank Permit Conditions: 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 4 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 5 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 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. D TIMLA APR 0 9 2026 OFFICIAL USE ONLY MASON DATE RECENED: / ' Ocj / ypxarz. If cn > COMMUN SERVICES AMOUNTRECEIVED: O RECEIVED BY: Dill Public Health(Community Health/Environmental Health) W � 'bnxe�R3 360-427-9670,ext.400 or 360-275-4467,ext.400 1� /� 415 N.6th Street-Shelton,WA 98584 S W G D _ Ol N o 0 �/� Z C/) ON-SITE SEWAGE TANK ONLY APPLICATION m APPLICANT PHONE m MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 9 m SITE ADDRESS-STREET,CITY,ZIP CODE X 77c c C.EA lid NAME OF DESIGNER PHONE I'2 w1 NAME OF INSTALLER PHONE D I9) Me 1a &- TYPE OF WORK(select one) DRINKING WATER SOURCE - ❑ NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT ❑ PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z COMPONENT(S)TO BE REPLACED/INSTALLED PUBLIC WATER SYSTEM ❑ SEPTIC TANK PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE I I ❑ OTHER 3 & / I w OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r V� o ❑ SURFACING SEWAGE EXISTING FAILURE ❑SHORELINE ❑ 100FT+PUBLIC/COMMUNITY WELLS C) SUBMITTALS ❑ 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS I� ❑ PLOT PLAN(REQUIRED) ❑TANK CROSS SECTION(REQUIRED) ❑ 10FT+DRINKING WATER SUPPLY LINES ❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) ❑ 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS Ic PLOT PLAN CHECKLIST 0 I ❑ PROPERTY LINES AND EASEMENTS ❑ EXISTING/PROPOSED STRUCTURES ❑ EXISTING/PROPOSED OSS COMPONENTS AND LINES ❑ WELLS WITHIN 100FT 0 WATER SUPPLY LINES ❑ DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... r v ❑ DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS ❑ NORTH ARROW ❑ SCALE BAR I(� DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) �J ,iJcSY o . l D r>�. t ✓&l r L OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT HOME SALE ❑COMPLAINT ❑OTHER: COMMENTS ITIONS ! /t7IvSEWAGE 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 ( I 6/iI� THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 APPROVED JUN 0 2026 ARSON COUNTY EN�1ROH�ENTAL HEALTN RET 13.80 ft. reU 8E U U °�° i :T Obi! - THREAE - 24=D E r A Rte ' 8r£lC TlxS�t ALVL f� T i 1'sYdi'1$56�t'9G•�'i _ t 7 C cai 246-272C $-^d epC Z e�� [� }., �`.nkS must meet S`:. nd&d required by d sewaZ � FIGURE.2 nanufacn3rer must be on Dept�_ alth list oft i. t _ _.... Fege 35 of 55 VIA fK?H PLIVROSdOn#337--022 4 C j PARc rJ If APPROVE JUN 012026 I S 1q.1 MASON COUfM ENV1fZONMENTAL?EALTM X13 RET 1 I // / / / I /1 .