HomeMy WebLinkAboutSWG2023-00419 TANK ONLY - SWG Application / Design - 10/3/2023 MASON COUNTY °15N6T"STREETS"ELT96 ,EXT 400
SH STREE SHEL ONVEXT400
BELFAIR:360-275-4467,EXT 400
de Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Tank Only Permit: SWG2023-00419
APPLICANT MCCREADY REVOCABLE LIVING Phone:
TRUST LEONARD P
Address: 3241 SE DEVONSHIRE PL PORT ORCHARD, WA 98366
OWNER MCCREADY REVOCABLE LIVING Phone:
TRUST LEONARD P
Address: 3241 SE DEVONSHIRE PL PORT ORCHARD, WA 98366
SEPTIC INSTALLER ANTHONY DEMIERO Phone: 360-877-5200
Address: PO BOX 1174 HOODSPORT, WA 98548
Site Address: 261 NE RAINTREE LN
Primary Parcel Number: 223315200043
Permit Description: RV holding tank
Permit Submitted Date: 10/03/2023
Permit Issued Date: 10/17/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 additional fees may be required upon installation of system).
Permit Expiration Date: 10/16/2026 (based on date of inspection)
Type of Work OSS New Construction
Components being Replaced: RV Holding Tank
Surfacing Sewage? No Existing Failure? No
Shoreline? No Horizontal Setbacks Met? No
Number of Bedrooms: 0 Drinking Water Source: Public Water System
Additional Details: Holding tank
Permit Conditions.
4 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
2 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.
MASON COUNTY DATE RECEIVER
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ON-SITE SEWAGE TANK ONLY APPLICATION z -0
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NAME OF DESIGNER
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TYPE OF WORK(select one) DRINKING WATER SOURCE N I�
KZ NEW CONSTRUCTION/UPGRADES ❑REPAIR/REPLACEMENT ❑ PRIVATE INOIVIOUAL WELL ❑ PRIVATE TWO-PARTY WELL z r
COMPONENT(")TO BE REPLACED/INSTALLED Zr PUBLIC WATER SYSTEM 4 r 1"i%,K r)+ t'/ -, ^eS
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❑ SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINE 100FTi-PUBLIC/COMMUNITY WELLS 0
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SUBMITTALS ' SOFTt PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS S Il3
❑ PLOT PLAN(REQUIRED) As TANK CROSS SECTION(REQUIRED) ET 1 OFT+DRINKING WATER SUPPLY LINES
❑ PUMP DETAILS(IF APPLICABLE) a WAIVER(S)(IF APPLICABLE) 3 SFT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS I"
PLOT PLAN CHECKLIST r I-
A PROPERTY LINES AND EASEMENTS a-EXISTING/PROPOSED STRUCTURES CEXISTING/PROPOSED OSS COMPONENTS AND LINES H
❑ WELLS WITHIN 10OFT 0 WATER SUPPLY LINES 43 DRIVEWAYS/PARKING SURFACE WATERS,STREAMS,RIVERS,ETC_. �\ F"<
fli DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS Et NORTH ARROW 'SCALE BAR I
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VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE DCOMPLAINT 0 OTHER:
OMMENTS I CONDITIONS
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SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS'.TANKS MUST MEET CURRENT MINIMUM 512E REQUIREMENTS,EQUIPPED WITH RISERS
AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER BF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 07/O92019
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