HomeMy WebLinkAboutSWG2026-00301 - SWG Application - 9/16/2026 MASON COUNTY 4,5N6THETREET,5HELTON WA985B0
SH STREE ,SHEL ON W EXT400
BELFAIR.360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT400
FAX'.360-427-7787
On-Site Sewage System Tank Only Permit: SWG2026-00301
APPLICANT CW HARMON INC Phone:
Address: 1281 W LOST LAKE RD SHELTON,WA 98584
OWNER CW HARMON INC Phone:
Address: 1281 W LOST LAKE RD SHELTON,WA 98584
SEPTIC DESIGNER CINDY WAITS* Phone: 360-701-0205
Address'. 80 E PICKERING LANE SHELTON, WA 98584
Site Address: 2105 BEVERLY BLVD
Primary Parcel Number: 320305106021
Permit Description: Septic tank replacement permit in city limits-OK per City of Shelton
Permit Submitted Date: 09/14/2026
Permit Issued Date: 0911612026
Issued By: Rhonda Thompson
Current Permit Fees Paid: $275.00 (additional mas may be required upon hstauadoo or eyten,t.
Permit Expiration Date: 09/16/2027 (based on date oflnspeotlon)
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: Public Water System
Additional Details: Sound Placement 1250g
Permit Conditions:
4 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
2 Horizontal setbacks per WAC246-272A-0210 must be 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.
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 055.
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.govlhealthienvironmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
.,snac.aI m wn e.see DATE BECDveO.
MASON COUNTY 1 Zc�3cv H s
COMMUNITY SERVICES FNOUNTRECENED: � AECFRIED �OF m y
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ON-SITE SEWAGE TANK ONLY APPLICATI --_ 3 p
APPLICANT PHONE 1 m In
MAXIMUS MCELHINNY 360-239-1541 z
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MAILINGAOORESS STREET,CITY STATE,LPDOOE -�
2105 BEVERLY BLVD, SHELTON, WA. 98584 00
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SITE ADDRESS.STREET,CITY 2IP CODE
2105 BEVERLY BLVD rl I (AT
NAME OF DESIGNER PHONE I
CINDY WAITE 3620-701-0205
NAME OF INSTALER PHONE I O
L S a -
tl m y IW TYPE OF RK IIIBe) DRINKING WATER SOURCE O
❑ NEW CONSTRUCTION)UPGRADES D REPAIR I REPLACEMENT O PRIVATE INDIVIDUAL WELL O PRIVATE TWO-PARTY WELL 2 IO
OOMPONENTIS)TO BE REPLACEW INSTALLED D PUBLIC WATER SYSTEM
II SEPTIC TANK ❑PUMP TANK ❑RV HOLDING TANK BEDROOMS LOT SIZE (n
D OTHER 2 .27 AC
OTHER DETAILS(WNsdatl,NlepP)y) TANKISI SETBACK CHECKLIST
❑SURFACING SEWAGE II EXISTING FAILURE D SHORELINE • 100FT+PUBLIC/COMMUNITY WELLS 0
SUBMITTALS SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS.RIVERS
M PLOT PLAN(REQUIRED) ■TANK CROSS SECTION(REQUIRED) a LOFT DRINKING WATER SUPPLY LINES
O PUMP DETAILS(IF APPLICABLE) D WAIVER(S)(IF APPLICABLE) • 5FT+PROPERTY)EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST y I
S PROPERTY LINES AND EASEMENTS ® EXISTINGI PROPOSED STRUCTURES i EXISTING/PROPOSED OSS COMPONENTS AND LINES
❑ WELLS WITHIN IOOFT ■ WATER SUPPLY LINES U DRIVEWAYS)PARKING ❑SURFACE WATERS.STREAMS,RIVERS,ETC... I
m DIRECTION OF SLOPE/CONTOURS D PERIMETER)CURTAIN DRAINS ■NORTH ARROW U SCALE BAR
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locbd AMR)
GO SOUTH ON OLYMPIC HIGHWAY, TURN LEFT ONTO PIONEER WAY, TURN LEFT
ONTO LAKE BLVD, LEFT ONTO WYOMING AVE, TURN LEFT ONTO BEVERLY BLVED.
PRESIDENCE IS ON THE CORNER OF BEVERLY BLVED AND CALIFRONIA AVE
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE l FAILURE SOURCE(fDr NA PFg purpo os)
D VOLUNTARY D MAINTENANCEIPUMPING D BUILDING PERMIT DHOME SALE DCOMPLAINT DOTHER:
COMMENTS I CONDITIONS
? 4( Q c AC
SEWAGE TANKS MUST BE USTED UNDER OOH LIST OF REGISTERED SEWAGE TANKS.TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EOUIPPEO WITH RISERS
AND LIDS TO SURFACE.AND I NCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD OWING AND INSTALLATION REPORT REQUIRED FOR FINAL A➢PROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED!ISSUED BY DATE
THIS FORM MAY BE SCANNEDAND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSRE REVISED IV7I2015
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