HomeMy WebLinkAboutSWG2026-00278 - SWG Application - 9/15/2026 4 MASON COUNTY 415 N 6TH STREET, N,WA 98584
SHIELTON:360-427-9670 EXT400
BELFAIR 360-275-4467 EXT 400
Public Health & Human Services ELMA.360-482-5259,EXT 400
FAX:300-427-7787
On-Site Sewage System Tank Only Permit: SWG2026-00278
OWNER WORTHINGTON STEVEN M &DENISE Phone:
Address 810 SE COLE RD SHELTON, WA 98584-8626
APPLICANT WORTHINGTON STEVEN M&DENISE Phone'
Address: 810 SE COLE RD SHELTON, WA 98584-8626
SEPTIC INSTALLER THAD BAMFORD' Phone: 360-790-2364
Address: 301 WALLACE KNEELAND BLVD STE 224-332 SHELTON, WA 98584
Site Address: 812 SE COLE RD
Primary Parcel Number: 320324200130
Permit Description: New 1200g septic tank to be installed to connect 810 SE Cole RD
home to existing 2bd OSS on 320324200130
Permit Submitted Date: 08/24/2026
Permit Issued Date: 09/15/2026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $275.00 taddlrmnanees flay 5e'e(Imred upon installation of system)
Permit Expiration Date: 09/15/2027 teased on(late at insoectioni
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Private Well/Spring
Additional Details: 1200 gallon septic tank
Permit Conditions:
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.
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 he maintained, unless prior approval is
obtained
1 Approval of this septic permit does not approve the building location. Building location is
subject to approval from all applicable departments and regulations.
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.govlhealth/environmental/onsiteloss-inspection-request.php or call:
360-427-9670,extension 400.
OFFICIAL USE ONLY- ------------------
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NAME OF DESIGNER PHONE ( N
NAME OF INSTAL I FR E
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NEW CONSTRUCTION/UPGRADES ❑❑ ❑ REPAIR!REFIACEMENT JQf PRIVATE INDIVIDUAL WELL ❑ PRIVATETWO-PARTY WELL $ IN
C NTIS TO BE REPLACED,INSTALLED ❑ PUBLIC WATER SYSTEM
(SEPTIC TANK ❑PUMP TANK O E HOLDING TANK BEDROOMS LOT SIZE
❑ OTHER a J J m
Oil I5R DETAILS 6&,9d all(pal apply) LANK s)SEIBACKCHECKU5T
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❑ SURFACING SEWAGE EXISTING FAILURE ❑SHORELINE ❑ 1DUFTLU PBLC COMMUNITY WELLS I0
SUBMITTALS ❑ SCFTe PRIVATE WELLS,SURFACE WATERS.STREAMS,RIVERS
PLOT PLAN(REQUIRED) k]TANK CROSS SECTION(REQUIRED) ❑ )OFT•DRINKING WATER SUPPLY LINES I
❑ PUMP DETAILS IIFAPP'LICABLEI ❑ WAIVER(S)(IFAPPLICABLEI 0 5FT-PROPERTY!EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOI
PROPERTY LINES AND EASEMENTS A EXISTING!PROPOSED STRUCTURES {EXISTING/PROPOSED 055 COMPONENTS AND LINES O \
WELLS WITHIN 100FT ❑ WATER SUPPLY LINES DRIVEWAYS!PARKING ❑ SURFACE WATERS,STREAMS.RIVERS.ETC .
���!❑1111 DIRECTION OF SLOPE!CONTOURS ❑ PERIMETER!CURTAIN DRAINS fl'NORTHARROW CALE BAR
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DIRECTIONS TO SITE AND SITE CONDITIONS (er lo.ded gee)
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OFFICIAL USE ONLY BELOW THIS LINE -
DRAOFI,A..I.JR SOURCF OLL-PYBq LOT"1 11
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER.
COMMENTSN CONDITIONS fi c lwF to � �
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SEWAGE TANKS MUST SE LISTED UNDER DON LIST OF REGISTERED SEWAGE TANKS'. TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS.ECUIPPED WITH RISERS
AND JOE TO SURFACE.AND INCLUDE AN EFFLUENT FILTER(IFAPPLICABL ) RE CORD DRAWING AND INSTAL I ATION REPORT REQUIRED FOR FiNALAPPRGVAL
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED:ISSUED DY DATC
THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 127126.5
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