HomeMy WebLinkAboutSWG2022-00367 - SWG Application / Design - 6/27/2022 415 N 6TH STREET,SHELTON,WA 98584
MASON COUNTY SHELTON:360-427-9670,EXT 400
COMMUNITY SERVICES BELFAIR:360-275-4467,EXT 400
ELMA: 360-482-5269,EXT 400
,qy Budding,Planning,Environmental Health,Community Health FAX:360-427-7787
On-Site Sewage System Permit: SWG2022-00367
APPLICANT HOUSTON CARLSON CAROLYN D Phone:
Address: 5082 WESTSIDE RD CLE ELUM, WA 98922
OWNER HOUSTON CARLSON CAROLYN D Phone:
Address: 5082 WESTSIDE RD CLE ELUM, WA 98922
SEPTIC DESIGNER DALE TAHJA-Septic Designer Phone: 360-426-5940
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: 80 N RAINBOW CIR
Primary Parcel Number: 422165200002
Permit Description: New 2bd ATU to pressure trench
Permit Submitted Date: 06/27/2022
Permit Issued Date: 06/30/2022
Issued By: Rhonda Thompson
Current Permit Fees Paid: $740.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/29/2025 (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: www.co.mason.wa.us/health/environmentallonsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY —
DATE RECEIVED:
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415 N.6th Street-Shelton,WA 9a584
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ON-SITE SEWAGE SYSTEM APPLICATION z
APPLICANT PHONE
Carolyn Houston Carlson (509) 260-0562 ,— c
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 7- E
P.O. Box 481 Cle Elum WA 98922 n M
SITE ADDRESS-STREET,CITY,ZIP CODE
80 N. Rainbow Circle Hoodsport WA 98548 2) I .gt,
NAME OF DESIGNER PHONE 2) I N
Dale L. Tahja (360) 425-5940
NAME OF INSTALLER PHONE 0 I N
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PERMIT TYPE(select one) DRINKING WATER SOURCE
RESIDENTIAL OSS Ali COMMUNITY OSS ICI COMMERCIAL OSS f PRIVATE INDIVIDUAL WELL EiPRIVATE TWO-PARTY WELL z I rn
TYPE OF WORK(select one) PUBLIC WATER SYSTEM Lake Cushman
M.NEW CONSTRUCTION/UPGRADES l REPAIR/REPLACEMENT OTHER DETAILS(select all hat apply) 0 TABLE IX REPAIR N I (71
SUBMITTALS ❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE W
M DESIGN FORM(REQUIRED) 1SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE O I N
b WAIVER(S)(IF APPLICABLE) 2 0.21 acre 0 .
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DIRECTIONS TO SITE AND SITE CONDITIONS:(ex locked gate)
Go up Lake Cushman from Hoodsport, left on Cushman Potlach Rd., left on Rainbow Way, I o
left on Rainbow Circle, second driveway on the left. o I o
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I N
OFFICIAL USE ONLY BELOW THIS LINE- -
UPGRADE/FAILURE SOURCE(for reporting purposes) 416
4/
i 0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE ['COMPLAINT ❑OTHER: I
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS w♦1,kt, � I
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RECORD DRAWING AND INSTALLATION REPORT IV 1
SOIL CODES: /
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY IZ DATE
THIS FORM MAY E SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 4 2 2 1 6 — 5 2 — 0 0 0 0 2
A design will be reviewed when 3 conies 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
'1 Scaled plot plan,including all applicable items on checklist. v 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"
PARCEL IDENTIFICATION
Permit Number: SWG 2 Zt 0O 5o—1 Designer's Name: Dale L.Tahja
Applicant's Name: Carolyn Houston Carlson Designer's Phone Number: (360)426-5940
Mailing Address: P.O.Box 481 Designer's Address: 2450 W. Deegan Rd.W.
Cie Elum WA 98922 Shelton WA 98584
City State Zip City State Zip
Treatment Device
❑Glendon Biofllter 0 Sand Filter 0 Mound ®Sand Lined Drainfield c:3 ReciYculatingFilter,Type:
I 'Aerobic Unit Make/Model BNR 500 NuWater 0 Disinfection Unit Make/Model Other:
Drainfield Type
❑Gravity g Pressure l 'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class Sch.40
Daily Flow:Operating Capacity 180 gpd Length 12, 24, 28 ft
Daily Flow:Design Flow 240 gpd Diameter 1.25 in
Septic Tank Capacity(working) NuWater gal Number 6
Receiving Soil Type(1-6) 4 Separation 9 ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 400 ft2 Total Number of Orifices 34
Designed Primary Area 400 ft2 Diameter 1/8 in
Designed Reserve Area 400 ft2 Spacing 48 in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 136 ft Schedule/Class Sch.40
Elevation Measurements Length 60 ft
Original Drainfield Area Slope 6 % Diameter 1.25 in
New Slope,If Altered 4 % Preferred manifold configuration used? 0 Yes ( f No
Depth of Excavation Up-slope 12 in Transport Pipe
from Original Grade Down-slope 10 in Schedule/Class Sch.40
Designed Vertical Separation 15 in Length 40 ft
Gravelless Chambers Required? ❑Yes 0 No Ig Optional Diameter 2 in
Pump Required? Ely Yes 0 No ° Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 4
Duff.in Elevation Between Pump&Uppermost Orifice 5 ft Dose quantity 45 gal
Drainfield Squirt Height/Selected Residual(head) 7 ft Chamber Capacity(flood) 1,000 gal
Uppermost Orifice E 'Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 16 gpm L 'Timer C 'Elapse Meter [(Event Counter
Calculated Total Pressure Head 16 ft If Timer: Lump an 2.8 ,pump off 5 hrs.57.2 min.
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number:4 2 2 1 6 — 5 2 -- 0 0 0 0 2
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
21 Test hole locations I71 Drainfield orientation and layout Reference depth from original grade:
O Soil logs 21 Trench/bed dimensions and 1 Septic tank
2 Property lines critical distances within layout 621 Drainfield cover
5/1 Existing and proposed wells 2 D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 21 Septic tank/pump chamber and restrictive strata:
21 Measurements to cuts,banks, and locations
61 Laterals,trench/bed,top and
surface water and critical areas 61 Observation port location bottom
57.1 Location and orientation of 21 Clean-out location 0 Curtain drain collector
curtain drain and all absorption 2 Manifold placement 0 Sand augmentation
components
IZE Orifice placement Other cross-section detail:
6~S Location and dimension of 2 Lateral placement with distance 2 Observation ports/clean-outs
primary system and reserve area to edge of bed
6/1 Buildings Other Information
Audible/visual alarm referenced Yes No
21 Direction of slope indicator 61 Scale of drawing shown on scale L1 ❑ Design staked out
61 Waterlines bar 0 0 Recorded Notices attached
61 Roads,easements,driveways, 0 ❑ Waiver(s)attached
parking 61 ❑Pump curve attached
O 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 be otifie y i er at time of installation 6t Yes 0 No at
or
Signature of Designer Date 4a4'`�� I`j
The undersigned has reviewed this design on behalf of Mason County Public Health and deters+,;z7*�:"`ib b "` •Z
compliance with state and local on-site regulations: M ,ap ��' " .1- Q;1 1
Environmental Healt Specialist Date .'�r
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CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONS! '! ")L
✓ The design is stamped"Approved"by Mason County Public Health. L/„„Y'�C �1 ,y
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✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: �/t✓ 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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Installation/Maintenance
Pressure Distribution/french Systems
1. Install french bottom level and in contour with the ground.
2. Install drainfield during dry weather and soil conditions. Any soil smearing must be
eliminated by hand raking any areas that get smeared.
3. Install audio/visual high water alarm.
4. Install effluent filter in septic tank outlet or pump vault with 1/16 inch maximum
filtration mesh size.
5. Install check valve in pump outlet line to prevent back-flow into the pump chamber.
6. Install 1/8 inch orifices on 4ft. centers. Install the orifices(with orifice shields)pointing
straight up ( 12:00 0' clock).
7. Divert all storm water run-off away from septic system components.
8. No curtain(french) drains allowed within 10ft. of the up-slope edge of the drainfield and
reserve area.
9. No curtain(french) drains allowed within 30ft. of the down-slope edge of the drainfield
and reserve area.
10.1lave the septic tankk-and pump chamber pumped or inspected every 3 to 5 years.
11.Inspect and clean pump screen as needed.
12.Inspect floats and test high water alarm every 6 to 12 months or as needed.
13.All material and workmanship must meet County and State requirements.
14.Install risers on septic tank and pump chamber.
15.Deviation from this approved design without prior approval from the Designer and
Mason County Health Department will make this design null and void.
16.The prepared Site Plan is not a survey, it is the owner's responsibility to verify property
line locations prior to installation. Any discrepancies must be reported to the Designer
immediately.
17.Locate all utilities prior to starting installation. APPROVED
JUN 3 0
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