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HomeMy WebLinkAboutSWG2024-00006 - SWG Application / Design - 1/3/2024 MASON COUNTY 415N 6TH STREET,SHELTON,WA 98584 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: SWG2024-00006 APPLICANT BAILEY HEIDI L& FORREST J Phone: Address: 7271 W SHELTON-MATLOCK RD SHELTON,WA 98584 OWNER BAILEY HEIDI L& FORREST J Phone: Address: 7271 W SHELTON-MATLOCK RD SHELTON, WA 98584 SEPTIC DESIGNER DALE TAHJA-Septic Designer Phone: 360-426-5940 Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584 SEPTIC INSTALLER TJ Goos-TJ's Excavating Phone: 360-490-0217 Address: 150 E MARISA PL SHELTON, WA 98584 Site Address: 7271 W SHELTON MATLOCK RD Primary Parcel Number: 420181400000 Permit Description: Repair/upgrade to 3bd gravity trench Permit Submitted Date: 01/03/2024 Permit Issued Date: 01/05/2024 Issued By: Rhonda Thompson Current Permit Fees Paid S805.00 (additional ees may be rammed upon Installation of system). Permit Expiration Date: 01/05/2025 (based on date or inspection) Permit Conditions: 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 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 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. 4 OFFICIAL USE ONLY C tlA DATE _ - � MASON COUNTY l ^ , > Bs COMMUNITY SERVICES MD ND5 M E m g PuMLHpNh(Community Health/Environmental Health) v C y la %:M _, ,Mm swG 'ID a� w 66 OC��o o 71 = en ON-SITE SEWAGE SYSTEM APPLICATION ; z APPLICANT PHONE m rm" Heidi & Forrest Bailey (360) 701-7864 c MAILING ADDRESS-STREET CITY,STATE,ZIP CODE 7271 W, Shelton-Matlock Rd. Shelton WA 98584 Bn SITE ADDRESS-STREET CITY,ZIP CODE 7271 W. Shelton-Matlock Rd. Shelton WA 98584 I a NAME OF DESIGNER PHONE I N Dale L. Tahja (360) 426-5940 NAME OF INSTALLER PHONE O I 0 T. J. Coos (360) 490-0217 w I c p PERMIT TYPE(select(selectone) DRINKING WATER SOURCE o I RESIDENTIAL O55 LI:.COMMUNITY OSS 41'COMMERCIAL OSS lit PRIVATE INDIVIDUAL WELL 6:PRIVATE NA-PARTY WELL 2 I � TYPE OF WORK!seta ones DI PUBLIC WATER SYSTEM h;NEW CONSTRUCTION/UPGRADES g REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I I -A SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE 03 LmDESIGN FORM(REQUIRED) FSSEPTIC DESIGN(REQUIRED) BEDROOMS LOTSQE Q I a 1WAIVER(S)(IF APPLICABLE) 3 4.8 acres a I 0 DIRECTIONS TO SITE AND SITE CONDITIONS:(e))lockedgero) Go out of Shelton on the Shelton-Matlock Rd. to Dayton, first driveway past Little Eygpt Rd. I I o on the left. a I o ti This is a repair to a failing septic system that meets today's standards, upgrading to a 3 I o bedroom. WE MUST BE RAGGED FROM MAN TOAD AND TEST HOLES.MIST BE FLAGGED NTIN TEST HOLE MAWRS I 0 OFFICIAL USE ONLY BELOW THIS LINE UPGRADE I FAILURE SOURCE(for reporng purposes) ❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT OHOME SALE DCOMPLAINT[�[gEa.,_ INSPECTOR SOIL LOGS COMMENTS))a�• DNS a -\\ 0 'tot vJ I (— ) b5t bo 6M- ito e JAN 0 < 1024 �•�� ��� ' 1 9 Ir-(Vil it Q 1 �; V 5L ' .. J SOILCODES: RECORD DRAWING AND INSTALLATION REPORT Lta i, V=VERY GRAVELLY S=SAND L=LOAM SI a SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICAPON APPROVED/ISSUED BY DATE XISIz9 t ) cIzs AUMVAVICSVYi \-IcJ2 THIS FORM MAY sk SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 1272016 • DESIGN FORM—PAGE ONE Assessor's Parcel Number: 4 2 0 1 8 — 1 4 — 0 0 0 0 0 A design will be reviewed when 3 copies of each of the following are submitted: °1 Completed design form that has been signed and dated. s Scaled layout sketch, including all applicable items on checklist Scaled plot plan,including all applicable items on checklist. a 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 taper size: I1' X I7" . .. �'.ER1lG'f.LIDFk197kzGACLtDN'" Permit Number: SWG �OZ`1-0 O DOei Designer's Name: DaleTahja Applicant's Name: Heidi&Forrest Bailey Designer's Phone Number: (360)426-5940 Mailing Address: 7271 W.Shelton-Matlock Rd. Desi er's Address: 2450 W Deegan Rd W Shelton WA 98584 Shelton WA 98584 City State Zip City State Zip p T I F' P OVE 3 Treatment Device ❑Glendon Hiotilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type: ❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: N/A JMV Erb 7rL0 Drainfield Type ...... fid Gravity ❑Pressure l7f Trench ❑Bed 0 Sub Suffice Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 3 Schedule/Class 3034 Daily Flow: Operating Capacity 270 gpd Length 67 ft Daily Flow:Design Flow 360 gpd Diameter 4 in Septic Tank Capacity(working) 1,250 gal Number 3 Receiving Soil Type(1-6) 4 Separation 10 ft Receiving Soil Appl.Rate 0.6 gpd/ft' Orifices Required Primary Area 600 ft' Total Number of Orifices Gravity Designed Primary Area 600 1112 Diameter Gravity in Designed Reserve Area 600 ft2 Spacing Gravity in Trench/Bed Width 3 ft Manifold Trench/Bed Length 200 ft Schedule/Class 3034 Elevation Measurements Length 30 ft Original Drainfield Area Slope 7 mu Diameter 4 in New Slope,If Altered 7 /e Preferred manifold configuration used? 0 Yes DCNo Depth of Excavation up-slope 27 in Transport Pipe from Original Grade Down-slope 24 in Schedule/Class 3034 Designed Vertical Separation 45 in Length 90 ft Gravelless Chambers Required? 0 Yes 0 No 61Optional Diameter 4 in Pump Required? ❑Yes 51 No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day Gravity Diff.in Elevation Between Pump&Uppermost Orifice ft Dose quantity Gravity gal Drainfield Squirt Height/Selected ResidualChamber Capacity(head) ft � i ty(flood) Gravity gal Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required. Capacity®Total Pressure Head Gravity gpm OTimer OElapse Meter 0 Event Counter Calculated Total Pressure Head ft If Timer: Pump on N/A Pump off N/A Comments This a repair to a failing septic system that meets today standards, upgrading to a 3 bedroom. See pumper report for cause of failure. DESIGN FORM—PAGE TWO Assessor's Parcel Number:4 2 0 1 8 — 1 4 -- 0 0 0 0 0 Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch Md Test hole locations Iii Drainfield orientation and layout Reference depth from original grade: pi Soil logs 0 Trench/bed dimensions and el Septic tank Eb Property lines critical distances within layout Qf Drainfield cover Md Existingandproposed wells 0 D-Box/Valve box locations Reference depth from original grade within l00 ft of property 0 Septic tank/pump chamber and restrictive strata: m Measurements to cuts, banks,and locations Laterals,trench bed,top and surface water and critical areas RI Observation port location bottom RI Location and orientation of EL Clean-out location 0 Curtain drain collector curtain drain and all absorption Ed Manifold placement ❑ Sand augmentation components 0 Orifice placement Other cross-section detail: 121 Location and dimension of 0 Lateral placement with distance El Observation ports/clean-outs primary system and reserve area to edge of bed g Other Information • Buildings 0 Audible/visual alarm referenced Yes No • Direction of slope indicator 0 Scale of drawing shown on scale g PNl 0 Design staked out Ed Waterlines bar 0 0 Recorded Notices attached m Roads,easements,driveways, 0 0 Waiver(s)attached parking 0 0 Pump curve attached Ed North arrow and scale drawing 0 0 Evaluation of failure shown on scale bar Non-residential justification ❑ ❑ Waste strength ❑ ❑Flow DESIGN APPROVAL The undersigned designer t ben tified ins rat time of installation 0 Yes 0 No • Signature of Designer Date The undersigned has reviewed this design on behalf of Mason County Public Health and dete`.,^•• : 'Mktg L compliance with state and local on-site regulations: ._ i Environmental Health Specialist Date Si b‘toclio., CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDI .t`t ✓ The design is stamped"Approved"by Mason County Public Health. I1ll ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: ' " / 7/C ill, ✓ 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 Mason County WA GIS Web Map dkvinA 4. 5 r .�Yxly v - •_ tx �� � E" S u a . fl w.10 Y: 12/30/2023, 12:02'57 PM 11 5eg^g� � 0 �A P ¢OB �,J V E D 05 MI Sr,Ak� 1-- -I o County Boundary 0 0.02 JAN04) 5 2P23 0.08km ❑ No Filled - \ O\%- \\-ce...6� Site Address (Zoom in to 1:3,000) rrSoo Esn,MeXer EMM1eW Ge:y�repnks.and the GIS User Cuenmry uni Ell Tax Parcels (Zoom in to 1:30,000) \C1t \—n(,%,eS\ \? 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