HomeMy WebLinkAboutSWG2022-00345 - SWG Application / Design - 6/16/2022 Ti MASON COUNTY
415 N 6
SHELTON: 60-427-9670,EXT 400
hibrr COMMUNITY SERVICES BELFAIR:360-275-4467,EXT 400
,, ELMA:360-482-5269,EXT 400
Building,Planning,Environmental Health,Community Health
FAX:360-427-7787
On-Site Sewage System Permit: SWG2022-00345
APPLICANT PROUTY FRANCES & DONALD Phone: 360.831.7244
Address: 990 E STRONG RD SHELTON, WA 98584
OWNER PROUTY FRANCES & DONALD Phone: 360.831.7244
Address: 990 E STRONG RD SHELTON, WA 98584
SEPTIC DESIGNER Bob Paysse -Pioneer Digging Inc Phone: 360-426-1803
Address: 3083 E Mason Benson Road GRAPEVIEW, WA 98546
Site Address: E Strong Rd
Primary Parcel Number: 221287700080
Permit Description: New SFR -6BR Gravity
Permit Submitted Date: 06/16/2022
Permit Issued Date: 06/29/2022
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $500.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/21/2025 (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/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
:, MASON COUNTY DATE RECEIVED: ;//‘ oa 0 N
L .II. `-) COMMUNITY SERVICES AMOUNT RECEIVED (/C /aRECEIVED BY: L. CO m
--'-� Public Health(Community Health/Environmental Health) C u)
450-4 thS ext.400or n 27 47,ext.400
415 N.6th Street-Shelton,WA 98584 S W G ^O a a - LIS ' 2
L ON-SITE SEWAGE SYSTEM APPLICATION
m C)
APPLICANT PHONE m
r
DONALD PROUTY c
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE E
990 E STRONG ROAD SHELTON WA 98584 m
xi
SITE ADDRESS-STREET,CITY,ZIP CODE
XXX E STRONG ROAD SHELTON WA 98584 I I"
NAME OF DESIGNER PHONE I N
ROBERT H. PAYSSE 360-426-1803
NAME OF INSTALLER PHONE I
v
TBD
PERMIT TYPE(select one) DRINKING WATER SOURCE - I r`)(
RESIDENTIAL OSS COMMUNITY OSS COMMERCIAL OSS In PRIVATE INDIVIDUAL WELL 5-PRIVATE TWO-PARTY WELL Z
I CO
TYPE OF WORK(select one) Q PUBLIC WATER SYSTEM
Ig.NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) El TABLE IX REPAIR I I
SUBMITTALS ElSURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
DESIGN FORM(REQUIRED) 1g SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE 0ail I
57WAIVER(S)(IF APPLICABLE) 6 5 ACRE Z ,
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) o
NORTH HWY 3. RIGHT ON PICKERING ROAD. PAST STORE AND FIRE STATION, I I o
TURN LEFT ON STRONG ROAD. FOLLOW STRONG ROAD 1/2 MILE TO NEWLY r
CLEARED LOT ON LEFT SIDE OF ROAD. PDI SIGN POSTED. SEE SITE PLAN. o 0
co
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. CD
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE ['COMPLAINT 0 OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
U_t2- LS
- Y4 .1- 4A-3
z cQ
I Utm-4.
SOIL CODES: RECORD DRAWING AND INSTALLATION REPORT
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
NSP TSR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
idi Alm.--), 1.'2-1 22_ (a-21`25 04 tT 1 (3-421
TH F.IT AY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE 1 REVISED 12/7/2015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 1 2 8 — 7 7 — 0 0 0 8 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"
PARCEL IDENTIFICATION
Permit Number: SWG ;6)-1— 003 IS Designer's Name: ROBERT H. PAYSSE
Applicant's Name: DONALD PROUTY Designer's Phone Number: 360-426-1803
Mailing Address: 990 E STRONG ROAD Designer's Address: 3083 E MASON BENSON ROAD
SHELTON WA 98584 GRAPEVIEW WA 98546
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
'Gravity 0 Pressure C 'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms SIX Schedule/Class 2729 PERF
Daily Flow:Operating Capacity 540 gpd Length 50 ft
Daily Flow:Design Flow 720 gpd Diameter 4 in
Septic Tank Capacity 2250 gal Number 6
Receiving Soil Type(1-6) 3 Separation 9 ft
Receiving Soil Appl.Rate 0.8 gpd/ft2 Orifices
Required Primary Area 900 ft2 Total Number of Orifices -
Designed Primary Area 900 ft2 Diameter - in
Designed Reserve Area 900 ft2 Spacing - in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 300 ft Schedule/Class 3034
Elevation Measurements Length 40 ft
Original Drainfield Area Slope 3 % Diameter 4 in
New Slope,If Altered 3 % Preferred manifold configuration used? C 'Yes 0 No
Depth of Excavation Up-slope 12 in Transport Pipe
from Original Grade Down-slope 11 in Schedule/Class 3034
Designed Vertical Separation 36+ in Length 150 ft
Gravelless Chambers Required? 0 Yes 0 No 0 Optional Diameter 4 in
Pump Required? 0 Yes 0No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day -
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity - gal
Orifice - ft Chamber Capacity - gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head - Timer ❑Elapse Meter 0 Event Counter
Calculated Total Pressure Head - �IRiVnEbo - ,Pump off
Comments JUN 2 8
M4�ph1COUNTYE Z�Zz
NVIRON
MEN1.
TAL HEAT TN
JBIry
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 2 1 2 8 -- 7 7 -- 0 0 0 8 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
O Test hole locations 121 Drainfield orientation and layout Reference depth from original grade:
O Soil logs g Trench/bed dimensions and g Septic tank
g Property lines critical distances within layout g Drainfield cover
g Existing and proposed wells g D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 10 Septic tank/pump chamber and restrictive strata:
g Measurements to cuts,banks, and locations 0 Laterals,trench bed,top and
surface water and critical areas 10 Observation port location bottom
10 Location and orientation of 10 Clean-out location 0 Curtain drain collector
curtain drain and all absorption g Manifold placement 0 Sand augmentation
components 10 Orifice placement Other cross-section detail:
IZI Location and dimension of 10 Lateral placement with distance [I Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
66 Buildings g a udible/visual alarm referenced Yes No
Pi Direction of slope indicator ;' al i f a d 0 Design staked out
Ed Waterlines ' 0 rif Recorded Notices attached
O Roads,easements,driveways, JUN 2 8 o i I Waiver(s)attached
parking ZU12 ❑ g Pump curve attached
g North arrow and scale drawing MASON COUNTY ENVIRONMENTAL HEALTH 0
Evaluation of failure
shown on scale bar JBW Non-residential justification
❑ g Waste strength
❑ 10 Flow
DESIGN APPROVAL
The undersigned designer must be notified by installerat time of installation g Yes 0 No
(240 Por
6( if —
Signature of Design Date
The undersigned has reviewed thi :: ign on behalf of Mason County Public Health and determined it to be in
compliance with state and local • : regulations:
,✓ �1i W A. v L ` 4- '
Envi on IVI Health Specialist Date
CAUTION: DESIGN APPRO AL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: 6 - 2-( 2 5
V 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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PIONEER DIGGING, INC. CUSTOMER: DONALD PROUTY TEST HOLE I: TEST HOLE 2: TEST HOLE 3:
PARCEL#:22128 77 00080 0-12 GLS lN2 GLS 0-12 GLS
12 60 Ci\1S 12 60 GMS 12-48 C:MS
SEPTIC DESIGNS ADDRESS: XXX E STRONG ROAD 48+COMP SAND
3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE PLATDISCLAIMER:THIS IS S OR SURVEYS FIE LLD MEASUREMENTS AND COUNTY EY.REFERENCES INCLUDE
DESIGN INTENDED FOR SEPTICIC
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PURPOSES ONLY PROPOSED MAY BE SUECT TO OTHER OFFICE-360-426-1803 FAX-360 427-2353DEPARTMENT AGENCY REVIEW.DESIGNER NOTP RESPONSIBLE FOR SETBACKS UNRELATED TO
SHEET: SITE PLAN SCALE 1" 50' SEPTIC COMPONENTS.
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AN ASBUILT/INSTALL SIGNOFF FEE WILL
-I �� / BE CHARGED AT TIME OF INSTALLATION
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SEPTIC DESIGNS ADDRESS: XXX E STRONG ROAD 48+COMP SAND
3083 MASON BENSON RD. GRAPEV1EW,WA 98546 DESIGNER: ROBERT H.PAYSSE DISCLAIMER:THIS IS NOT A SURVEY.REFERENCES INCLUDE'APPLICANT/COUNTY PROVIDED
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Installation & System Notes
1. Installer must contact designer for final inspection of the installation prior to cover. All components, including tanks, lids,
transport line, drainfield, and water lines must be open for inspection. A$300.00 fee will be charged for time involved with the
inspection of the installation and creation of the record drawing. The designer reserves the right to charge additional fees if
multiple visits are needed due to installation errors or inaccessible components.
2.This septic design must be installed by a certified installer with the local health department. All components shall be installed
according to state, county, and manufacturer requirements. For Homeowner Installs,the owner must get approval from the
designer and local health department prior to attempting installation.
3. Designer is not a surveyor. Installer must familiarize themselves with property line locations prior to installation. Any
confusion or conflicts with line locations should be reported to the property owner. A licensed surveyor may be necessary prior
to installation to confirm all line locations. Any discrepancies found must be reported to the designer immediately.
4. Drainfield area may only be cleared by a licensed installer familiar with sensitive drainfield area preservation. The builder, lot
developer, or property owner shall not clear the drainfield area. Any clearing required for drainfield installation shall not
remove or disturb any top soil in Primary and Reserve areas. Removal or disturbance to drainfield soils could render design
void.
5.The property owner and installer are responsible for locating all underground utilities (ex. water,gas,electric) prior to
installation. Any utility locations shown within design drawings are likely approximate and may not be exact.
6. All proposed tanks must be installed on original soils or compacted gravels. Extend all tank connection lines out onto original
soil to avoid settling issues. Risers and lids must be brought to finished grade and left accessible for future operations and
maintenance. Component manufacturers (ex. ATU, Glendons,) may have other requirements not listed within this design.
7. All electrical wiring shall be done by a licensed electrician or homeowner(if allowed) and must be permitted through Labor
and Industries.
8.The proposed septic system should be installed in dry weather conditions. Any failed attempts at installation during wet
weather conditions may render this design void.
9. Maintain 10ft to waterlines with all septic components. If less than 10ft is required,sleeving in sch. 40 pvc is required. If
sewage transport lines and waterlines must cross,waterline must be 18" above sewage line with one of the lines sleeved in sch.
40 pvc 10ft in each direction of crossing.
10.This design may include waiver applications with specific mitigation measures pertaining to installation,operation and
maintenance of the proposed components.
11. Stormwater runoff,footing drains, roof drains must be diverted away from any septic system components. No curtain,
foundation, perimeter drains shall be installed 30ft downslope and 10ft upslope of drainfield areas.
12.This design is site specific and intended to meet state and county requirements that are related to the system components
being proposed. Any placement of proposed buildings, proposed wells or other non-related items ondr wings may or
may not meet other requirements. P0
13.All onsite septic systems require regular maintenance to verify satisfactory operation. T em �p r eratA'i
P Y q g � gg
4
responsible for the continuous operation and maintenance of the system per WAC 246-272A. .44-COmptioniikitena
information, refer to Mason County Public Health Homeowner's Manual,which should be received aftetirkit ly,ion' ppr
14. System owner should be cautious of landscaping around septic components. Root intrusion 14e14/ MENTq(HFq�Ty
can cause premature failure of the drainfield area. In addition, bushes and trees should be kept
away from lids and other septic maintenance points. /
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CUSTOMER: DONALD PROUTY 1,���: '� • `
PIONEER DIGGING, INC. PARCEL#:22128-77-00080 I/a.. . ,, H VAVSSE �
SEPTIC DESIGNS ADDRESS: xxx E STRONG ROAD ,b ,°k2T '
3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE EXPIRES
OFFICE-360-426-1803 FAX 360-427-2353 SHEET: NOTES SCALE NA