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HomeMy WebLinkAboutSWG2023-00095 - SWG Application / Design - 3/17/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 i■ 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 Permit: SWG2023-00095 APPLICANT FITZPATRICK ET UX GERARD A Phone: Address: 70 NE Queen Ann Dr BELFAIR, WA 98528 OWNER FITZPATRICK ET UX GERARD A Phone: Address: 70 NE Queen Ann Dr BELFAIR, WA 98528 SEPTIC DESIGNER ROD LEFT -Acme Design Phone: 360-698-8488 Address: PO Box 2954 SILVERDALE, WA 98383 Site Address: XXX NE Queen Ann Dr Primary Parcel Number: 322137590030 Permit Description: 3-bedroom gravity system Permit Submitted Date: 03/17/2023 Permit Issued Date: 05/26/2023 Issued By: David Anderson Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system). Permit Expiration Date: 03/21/2026 (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 v e DATE RECEIVED: °''''-''`"1 MASON COUNTY cn D II. =i COMMUNITY SERVICES AMOUNT RECEIVED: RECENED BY: co cn � - o m �,�`,„.. Public Health(Community Health/Environmental Health) - -- N '-lr_l.,,,„,on` 3 6042 7-96 7 0,ex 40 4ext.0 of 360-275467,e .400 CP 415 N.6th Street-Shelton.WA 98584 S W G 010 a 3 co O 13p 73_ Z (n ON-SITE SEWAGE SYSTEM APPLICATION D D Qc APPLICANT PHONE m m `41»s4k�# Gerard & Catherine Fitzpatrick 360-286-1998 Z c C �J MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE g ,\\ y 70 NE Queen Ann Drive _ Belfair WA 98528 m xi SITE ADDRESS-STRFFT CITY 71P CODE NE Eeed Rd. & Belfair WA 98528 I W NAME OF DESIGNER PHONE I N Rod Left 360-698-8488 NAME OF INSTALLER PHONE I N _C PERMIT TYPE(select one) �� ��;; DRINKING WATER SOURCE Cn Lla.?RESIDENTIAL OSS DJCOMMUNITY OSS U�.COMMERCIAL OSS E PRIVATE INDIVIDUAL WELL IL_i)PRIVATE TWO-PARTY WELL 0 I C.) TYPEPEp��OF WORK(select one) Pr PUBLIC WATER SYSTEM Queen Anne Water Works LLC N04212 gc1:NEW CONSTRUCTION/UPGRADES ElREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE IX REPAIR I �J SUBMITTALS a�++ 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE LCLDESIGN FORM(REQUIRED) WI SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE W I U-1 yp_WAIVER(S)(IF APPLICABLE) 3 30,056 o I DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) O IO CO SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. 0 OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS -Pt1: D- t-If'‘ 1-.IS -Ft t z: d- 3I )I L-IS 30- (-iz 6TS T lt,: 0-2 '` Lm5 Zen- 1 a Cr1S RECORD DRAWING AND INSTALLATION REPORT SOIL CODES: V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL. I.TOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE 3/z.'lzoU 3/z1 / 776* THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 4 . . DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 2 1 3 — 7 5 — 9 0 0 3 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. 'I 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" '''-..7 "„„-°7?-: ., I-.:;•. k. .i.'.....f •catibi.,gft-.7iii..,t,M1 if*Ottg.iii; -'''',.•ii-:,,,',ti F....117:i' Permit Number: SWG _ Designer's Name: Rod Left Gerard&Catherine Fitzpatrick 360-698-8488 Applicant's Name: Designer's Phone Number: Mailing Address: 70 NE Queen Ann Dr Designer's Address: PO Box 2954 Bed air WA 98528 Silverdale WA 98383 City State Zip City State Zip _._-'.:.„,ji;1_,e'''::'-: ,,--,:-___.'.:.,:....f•-,:,1 '.1'.*''','------ - :clMtigb:tltIERV:ivWtW.O'4CnVM.MRAW"R .4:,•... ,,.. ..•.,..' Treatment Device 0 Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type: 0 Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: Drainfield Type EiGravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 3 Schedule/Class 40 .Z' Daily Flow:Operating Capacity '36Q4 27 gpd Length 50 ft Daily Flow:Design Flow 360 gpd 7/ Diameter 4 in Septic Tank Capacity 1250 gal Number 3 .. --' Receiving Soil Type(1-6) 3 \ Separation 5 ft Receiving Soil Appl.Rate .8 gpdifty Orifices Required Primary Area 450 ft2 Total Number of Orifices NA Designed P-rimary Area 450 ft2 t/ Diameter NA in Designed Reserve Area 600+ ft2 I/ Spacing NA in Trench/Bed Width 3 ft / Manifold Trench/Bed Length 150 ft s--"' Schedule/Class NA Elevation Measurements .,,- Length NA ft Original Drainfield Area Slope 3 % / Diameter NA in New Slope,If Altered NA % Preferred manifold configuration used? 0 Yes 0 No Depth of Excavation Up-slope 16 in / . Transport Pipe from Original Grade .../ Do -slope 16 in .Schedule/Class 40 Designed Vertical Separation 1 8 in / Length 6 ft Gravelless Chambers Required? 0 Yes 0 No Ef Optional Diameter 4 in Pump Required? 0 Yes lif No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day NA Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity NA gal Orifice ft Chamber Capacity NA gal Uppermost Orifice CI Higher 0 Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head gpm OTimer 0Elapse Meter 0 Event Counter Calculated Total Pressure Head ft If Timer: Pump on puo Comments APPROVED MAY 2 6 2023 MASON COUNTY ENVIRONMENTAL HEALD' DJA DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 2 1 3 -- 7 5 — 9 0 0 3 0 Permit Number: SWG DESIGN CHECICLLSTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch g Test hole locations g Drainfield orientation and layout Reference depth from original grade: EZi Soil logs Ed Trench/bed dimensions and g Septic tank g Property lines critical distances within layout Drainfield cover ❑ Existing and proposed wells D-Box/Valve box locations Reference depth from original grade within 100 ft of property EZi Septic tank/pump chamber and restrictive strata: ❑ Measurements to cuts,banks,and locations 6d Laterals,trench bed,top and surface water and critical areas g Observation port location bottom ❑ Location and orientation of 12i Clean-out location 0 Curtain drain collector curtain drain and all absorption ❑ Manifold placement 0 Sand augmentation components 0 Orifice placement Other cross-section detail: • Location and dimension of Eli Lateral placement with distance g Observation ports/clean-outs primary system and reserve area to edge of bed g Other Information Buildings 0 Audible/visual alarm referenced Yes No g Direction of slope indicator g Scale of drawing shown on scale 0 g Design staked out g Waterlines bar 0 11 Recorded Notices attached Roads,easements,driveways, Ed 0 Waiver(s)attached parking 0 E2i Pump curve attached E 1 North arrow and scale drawing 0 RI Evaluation of failure shown on scale bar Non-residential justification ❑ ❑Waste strength ❑ ❑Flow DESIGN APPROVAL. The undersigned designer must be notified by' er at ' e of' lation lid Yes 0 No • ature of Designer Date The undersigned has reviewed this design on behalf of Mason County Public Health and det4i e�jiyy�b compliance with state and local on- ' lation ~ ;176/Z073 vironmental Health Specialist Date MAY 2 6 2023 MASON CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING COIQUITI(�D A NMENTAL HEALT!` ✓ 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 r.. Mason County WA GIS Web Map . 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