HomeMy WebLinkAboutSWG2023-00144 - SWG Application / Design - 4/19/2023 MASON COUNTY 415 N 6TH STREET,SHELTON, ,E,E 400 98584
SHELTON: 42 T 967XT
J I BELFAIR:360-275-4467,EXT 400
= _ Public Health & Human Services ELMA:360-482-5269, EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00144
APPLICANT Jacob Kennedy Phone:
Address: 200 E Rasor Lane BELFAIR, WA 98528
OWNER Jacob Kennedy Phone:
Address: 200 E Rasor Lane BELFAIR, WA 98528
SEPTIC DESIGNER PAULA JOHNSON -Arrow Septic Phone: 360-898-2255
Designs Inc.
Address: 171 E VUECREST DRIVE UNION, WA 98592
SEWAGE INSTALLER SOUTH SHORE CONSTRUCTION Phone: 360-801-4432
Address: PO BOX 963 BELFAIR, WA 98528
Site Address: 200 E Rasor Ln
Primary Parcel Number: 122077500410
Permit Description: 3-bedroom gravity system
Permit Submitted Date: 04/19/2023
Permit Issued Date: 04/26/2023
Issued By: David Anderson
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 04/25/2026 (based on date of inspection)
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
3 Drain field installation not to exceed designed upslope and downslope depth specified on
design form.
4 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
5 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
6 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
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 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/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY 0.t
DATE RECEIVED: 1 (t- <-'= MASON COUNTY4......
` ` ,,,���"""'''"""""" ��' ��' CD CD
,� ! COMMUNITY SERVICES AMDµN:RECF1jED� RECEIVE •
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Public Health(Community Heahh/EnvironmentalHealth; (n
3u0.N.5th Street
•aoc«n.WA 9 584 r.,.a S W G a(9- -� - O O Act . o
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ON-SITE SEWAGE SYSTEM APPLICATION
m 0
APPLICANT O\E m
r
Jacob Kennedy (360)265-5101 z
MAILING ADDRESS-STREET.CITY.STATE.ZIP CODE E
200 E Rasor Ln Belfair WA 98528 ea
SITE ADDRESS-STREET.CITY,ZIP CODE
Same ,
NAME OF DESIGNER PHONE I N
Arrow Septic Designs (360)898-2255
NAME OF INSTALLER PHONE Q N)
South Shore Construction 1 (360)275-0818
PERMIT�MI TYPE(selea one) DRINKING WATER SOURCE O
LPL O
RESIDENTIAL OSS COMMUNITY OSS COMMERCIAL OSS 1 PRIVATE INDIVIDUAL WELL O.PRIVATE TWO-PARTY WELL Z y
TYPE OF WORK(select one) PUBLIC WATER SYSTEM I
i NEW CONSTRUCTION/UPGRADES ff REPAIR/REPLACEMENT OT,ER DETAILS(select all tnal apply) 0 TABLE IX REPAIR I —1
SUBMITTALS ❑ SURF-ACING SEWAGE 0 EXISTING FAILURE 0 SHORELINECO
gDESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS I LOT SIZE 1- I
0_WAIVER(S)(IF APPLICABLE) 3 5.06 Acres o I O
DIRECTIONS TO SITE AND SITE CONDITIONS'(ex rotued pare)
Take Highway 3 towards Belfair. Turn left onto Highway 106. Turn left onto E Rasor Rd. c)
Turn left onto E Rasor Ln. On the right, "200 E Rasor Ln" is written on a blue sign on a r I -P
wooden fence. Call ahead so owner can lock up dog. '
ad 106
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I
CD
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(tor reportng purposed
0 VOLUNTARY 0 MAINTENANCEJPUMPING 0 BUILDING PERMIT ['HOME SALE ❑COMPLAINT 0 OTHER:
INSPECTOR�(( SOIL LOGS / COMMENTS I CONDITIONS
T(T1: (2'5 GS
G 5
11 APR 1 9 2023 u
LLi
____.Yy_
RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM St=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSP 0 SIGNATURE DATE'APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
y751,,,,,I `f�2S�ZOZ6
TH ORM'`MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12l/2015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 1 2 2 0 7 — 7 5 — 0 0 4 1 0
A design will be reviewed when 3 copies of each of the following are submitted:
",Completed design form that has been signed and dated. Scaled layout sketch,including all applicable items on checklist
Scaled plot plan,including all applicable items on checklist. "Cross-section sketch,including all applicable items on checklist.
This form may be scanned and available for public view on the Mason County Web site.Maximum paper size: 11"X 17"
Permit Number: SWG Designer's Name: Arrow Septic Design
Applicant's Name: Kennedy �
Jacob Desi er's Phone Number: (360)898-2255
Mailing Address:
200 E Rasor Ln Designer's Address: 171 E Vuecrest Dr
Belfair WA 98528 Union WA 98592
City State Zip
City .VAr. Y4�State Wit
Treatment Device
❑Glendon Biofilter 0 Sand Filter ❑Mound ❑Sand Lined Drainfield 0 Recirculating Filter,Type:
O Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
Ili Gravity 0 Pressure ❑Trench C 'Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 2729
Daily Flow:Operating Capacity 270 gpd Length 45 ft
Daily Flow:Design Flow 360 gpd Diameter 1.25 in
Septic Tank Capacity(working) 1,200 gal Number 3
Receiving Soil Type(1-6) 3 Separation 3 ft
Receiving Soil Appl.Rate 0.8 gpd/ft2 Orifices
Required Primary Area 450 ft2 Total Number of Orifices —
Designed Primary Area 450 ft Diameter — in
Designed Reserve Area 450 ft2 Spacing — in
Trench/Bed Width 10 ft Manifold
Trench/Bed Length 45 ft Schedule/Class 2729
Elevation Measurements Length 6 ft
Original Drainfield Area Slope 1 % Diameter 4 in
New Slope,If Altered 1 % Preferred manifold configuration used? C 'Yes 0 No
Depth of Excavation tip-slope 18 in Transport Pipe
from Original Grade Down slope 16 in Schedule/Class 3034
Designed Vertical Separation 36+ in Length 160 ft
Gravelless Chambers Required? 0 Yes lid No ❑Optional Diameter 2" in
Pump Required? 0 Yes ElNo Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day —
Diff.in Elevation Between Pump&Uppermost Orifice — ft Dose quantity — gal
Drainfield Squirt Height/Selected Residual(head) — ft Chamber Capacity(flood) — gal
Pump controls:Please check those required.
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff
Capacity @ Total Pressure Head — gpm ❑Timer ❑Elapse Meter 0 Event Counter
Calculated Total Pressure Head — ft If Timer: Pi PP
rIpibff
Comments
APR 262023
MASON COUNTY ENV!RONMEhTAL rE'J:
1,4 DJA.
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 1 2 2 0 7 — 7 5 -- 0 0 4 1 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
g Test hole locations Drainfield orientation and layout Reference depth from original grade:
Ed Soil logs g Trench/bed dimensions and 6l Septic tank
Property lines critical distances within layout �( Drainfield cover
gExisting and proposed wells D-Box/Valve box locations Reference depth from original grade
within 100 ft of property g Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts, banks,and locations g Laterals,trench/bed,top and
surface water and critical areas 64 Observation port location bottom
❑ Location and orientation of g Clean-out location 0 Curtain drain collector
curtain drain and all absorption ES Manifold placement ❑ Sand augmentation
components 6S Orifice placement Other cross-section detail:
• Location and dimension of E Observation ports/clean-outs
primary system and reserve area g Lateral placement with distance
to edge of bed Other Information
Buildings 0 Audible/visual r • enced Yes No
g Direction of slope indicator ` .
It Scale of dra.yy,t •.•;` ��! scale Ei 0 Design staked out
g Waterlines bar e• •••�•y°�`1 ❑ El Recorded Notices attached
gRoads,easements,driveways, 1• ' . + . o 0 El Waiver(s)attached
parking ;� i' , 0 ❑ C�Pump curve attached
6 `, •g North arrow and scale drawing :;. �.• �ti 0 g Evaluation of failure� .., .�,
.�.
shown on scale bar :? 5ic0349 on-residential justification
PAULA JOY JOHNSON .?r ❑ [�Waste strength
UCI SttSUESIaNnI••
c ❑ El Flow
EXPIRES 1 t
DESIGN APPROVAL
The undersigned designer must be no t by installer time of installation El Yes 0 No
Signature of Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health M/Z E D
compliance with state and local on-s• e egulations: 4/
l 7Gl ZO 73 APR 2 6 2023
Environmental Health Specialist Date
MASON COUNTY ENVIRONMENTAL HEAL TF
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDI :
✓ The design is stamped"Approved"by Mason County Public Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval.
Please Note: The system must be installed by a certified installer,
unless prior authorization is obtained from Mason County Public Health.
An Installation Fee is required.
This form may be scanned and available for public view on the Mason County Web site.
Updated Date: 12/7/2015
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APPROVED
APR 2 6 2023
MASON COUNTY ENVIRONMENTAL HEALTF
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51CC349 � 4, O 1,200 Gallon Septic Tank
+-s`,• PAULA JOY JOHNSON l
aS.^•.1-j • -1N��_ 2-Compartment with Effluent Filter
EXPIRES 3 D-Box with speed-levelers
O and cover to surface
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ts„ APR ? 6 2023
4', Fer•C--eroted MASON COUNTY ENVIRONMENTAL HEALTH
A•5T'M 2:129 DJA
Dt+o.,,cam 'Dina oNA el sy 4& \-ts,C�, 0 bfi�'�°"�'
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Note: (Typical Bed Layout) ,-...-sib O
•
O=Observation Port—to be 4"p4rforated `. wady���
PVC pipe from bottom of bed to finished ` ?�;.�
410,
grade. A removable cap shall be installed on C /��; ; '
,�iGQ, f;7
observation port pipe. Glue"T"on bottom :,; s'00349 • �)\
so pipe can't be remove_. PAUL JOY JOHNSON
Minimum of 2 in system,one in each corner. I a t PAULA JO•dE HNSON '
Laterals are to be centered in trenches. "=�m�i
r DCPIRES 1
c--&,10-67
--- ►-� i v�ail
a— 12" t„ � u 12" c, °�
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SECURED LID wit?!GAS TIGHT SEAL
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CESS RIS13t \ • '
--.. )= / FINISN GRADE
n I-, .
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-7-11.1 ; TO PUMP
SEWAGE SOURCE FLOATING MAT __
APPROVED
4-_,__— BVIIIBIT
FILTER
SEDIMENTS
E /--________Nit_
• •
=1C TANK
•
m APPROVE C..
APR 2 6 2023
MASON COUNTY ENVIRONMENTAL HEALT'
OJA.
**Note: Septic Tanks must meet standards required by WAS chapter 246-272C
and manufacturer must be on the Dept of Health list of registered sewage tanks.**
5 (P
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(bilious. Septic Deoigna O
rho
INSTALLATION &MAINTENANCE - _: tA\
• y
Gravity Distribution Systems-Bed
=� 5?CC349
� �` PAULA JOY JOHNSON
with contour of the gm»nd LAC LA JOY JOHNS �i_
1. Install Laterals g_
2. Install bed bottom level.
3. Install locator tape or rebar at each end of all drainfield laterals.• um of 2
4. Install observation ports as indicated on the defiled drainfield layout. Minim
Lequired at diagonal corners of bed drainfield with bottom extending to the
drainrock/native soil interface. Glue"T"to bottom so Observation Port cannot be easily
removed from ground. Install removable cap on top of port at final grade
leve
5. Install drainfield during dry weather and soil conditions; any soil smearing must be
eliminated by hand raking. i down with 90-degree
6. Use distribution box with speed levelers. Divert incoming pipe
angle to prevent short-circuiting. If the drain rock extends above
7. Filter fabric required over drain rock prior to back filling.
natural grade,rim the filter fabric at least 2 inches down the trench wall.
8. Encase all water lines within 10' of drainfield and under any driveway/parking areas.
9. Divert all storm water runoff away from on-site sewage system.
10.No curtain drains allowed within 10' of the up-slope edge or 30' of the down-slope edge
of the drainfield and reserve area.
11.No vehicular traffic over drainfield area.
12. Install Bio-Tube or equivalent effluent filter at outlet mustof septic tank
have locking covers and.
13.All manhole lids and aS sampling inspection.ports
be located at ground level.
14.Inspect tank and clean filters every 6-12 months as needed.
15.Have the septic tank pumped or professionally inspected every 3 to 5 years.
16.All materials and workmaship must meet County and State regulations.
17.Deviation front this design without prior approval from the Designer and Mason County
Environmental-Health Department will make this design null and void.
18. All transport lines under driveways or parking areas must be encased to prevent crushing.
19.Homeowner is responsible for all property lines.
APPROVFEI
APR 262023 •
MASON COUNTY ENVIRONMENTAL HEALTh
DJ.A
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