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HomeMy WebLinkAboutSWG2022-00323 - SWG Application / Design - 6/7/2022 c 415 N 6TH STREET,SHELTON,WA 98584 Y, MASON COUNTY SHELTON:360-427-9670,EXT 400 (� COMMUNITY SERVICES BELFAIR:360-275-4467,EXT 400 ELMA:360-482-5269,EXT 400 Building,Planning,[nvi,an neat,I Mxalth,Community t lealth . FAX:360-427-7787 it:Pt . On-Site Sewage System Permit: SWG2022-00323 APPLICANT DOUG SMYTHE ET.AL. Phone: 360-495-3964 Address: 381S BIRCH ST MCCLEARY, WA 98557 OWNER DOUG SMYTHE ET.AL. Phone: 360-495-3964 Address: 381S BIRCH ST MCCLEARY, WA 98557 SEPTIC DESIGNER CHRIS ELSTROTT-Advanced Phone: 360-561-5000 Engineering Address: 128 NORTH RIVER STREET MONTESANO, WA 98563 Site Address: 240 W EICH RD Primary Parcel Number: 419252390030 Permit Description: New two bdrm-shallow pressure trench Permit Submitted Date: 06/07/2022 Permit Issued Date: 07/08/2022 Issued By: Luke Cencula Current Permit Fees Paid: $740.00 (additional fees may be required upon installation of system). Permit Expiration Date: 06/23/2025 (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 Drainfield installation not to exceed designed upslope (12') and downslope (6') depth specified on design form. Minimum 6"appropriate cover required. 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. 7 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 8 Gravel-less technology required by design. 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/onsite/oss-inspection-request.php or call: 360-427-9670, extension 400. 113031(73/11 JUN 0 6 2022 .�,.. DATE RECEIVED_ '' ' ti' MASON COUNTY _--1 __ - , 0 a f,:n7r ,, COMMUN I-, R�- £*g AMOUNT RECEIVED BY. oh C Public Health(Community Health/Environmental Health) ,, C 0) ..�. >>'` 360-427-9670,ext.400 or360-275-4467,ext.400 /+ /� 415 N.6th Street-Shelton,WA 98584 `\/ c^ a a_ _03 ( O 73 i 2-3 , ON-SITE SEWAGE SYSTEM APPLICATION In• f) APPLICANT PHONE ITI I- A UG Sri7�ir A. �T , . 36o - g7o - . -,4 s— ul c MAILING ADDRESS-STREET,CITY-STATE,ZIP CODE 7i 33 j Sr 3/,cy s T ic.. GGc'A/?yam u,I9 ?8 rS' 7Z- m SITE ADDRESS-STREET,CITY,ZIP CODE • Ir- NAME OF DESIGNER PHONE I N 'VP 1 /-..GsT i/7 3 - sZ/- c-a oa NAME OF INSTALLER PHONE 0 /s'/L / 2G.,.s. G4%)4's 7'• 3Ga - `l-7.0 - 87 , =4 < IN PERMIT TYPE one) DRINKING WATER SOURCE Cfi r.._ � � p SIDENTIAL OSS el COMMUNITY OSS In COMMERCIAL OSS 1_TPRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z TYPE OF WOR (select one) 0 PUBLIC WATER SYSTEM I W CONSTRUCTION/UPGRADES ❑ REPAIR!REPLACEMENT OTHER DETAILS(select ae that apply) ❑TABLE IX REPAIR IN --SUBMITTALS- El SURFACING SEWAGE ❑EXISTING FAILURE 13 SHORELINE ,_F� P 6ESIGN FORM(REQUIRED) TIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r• I tv fI WAIVER(S)(IF APPLICABLE) / 7/ 4G n DIRECTIONS TO SITE AND SITE CONDITIONS:(ex locked gate) • I\ii 4/grr oil/ SR? /off .• A,7 o '„ ,E/c-df cl — c s c^a ( .t t dfe- eves k) C/ 4, OA/ en / 7A/7- .• 2 v o G./• /c`iG/-/. ' 2 p Id Cc // o ,2 -rx Gvr►� —r�i IC W W SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I O OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS CDo... 35" s; L t. - AFN M,S;.‘:-A-4.-, . QD 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. 1 INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE Cot?)) J;.i - ? ,5'0,-5 -(al�7y ;<+ IS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBS REVISED 12/7/2015 DESIGN FORM-PAGE ONE Assessor's Parcel Number: _y/ Z S-- 2- 3 -- 1'67 4 3 O 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 I 7" � PARCEL IDENTIFICATION t `^ Permit Number: SWG (1�. -G oc^^.3 Designer's Name: C/ff-re./S /g"G s77f.• 1r- Applicant's Name: , S(iG S.-/n1 Gf TA"r- Designer's Phone Number: 36o- -6/ 'O o D Mailing Address: .?B/ .5". £i2C// c7. Designer's Address: /2 a /v- 2/v'2 S 7-- Mc-c"-;a e y,A//q 98 sr- ma v7 4,44 gees-4 3 City State Zip City ate Zip DESIGN PARAMETERS GO Treatment Device ❑ Glendon Bio land Filter 0 Mound 0 Sand Lined Drainfield APPRONIED--- ❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: field Type JUL 0 S 20�1 D 'n ���.i ❑ Gravity D Dressure Trench ❑ Bed ,%ROIy alli 'Surface •Drip WON COUNTY E Septic Tank/Drainfield Specifications Latiag Number of Bedrooms Z Schedule/Class /d Daily Flow: Operating Capacity Z//o (g 0 gpd Length ,SU ft Daily Flow: Design Flow 2/!? gpd Diameter /7/ in Septic Tank Capacity(working) /zip gal Number 4/ Receiving Soil Type(1-6) 5" Separation 9 ft Receiving Soil Appl.Rate 0, 41 gpd/ft2 Orifices Required Primary Area 6 -'a ft2 Total Number of Orifices 6'° Designed Primary Area IGO ft2 Diameter „3//� in Designed Reserve Area g aQ ft2 Spacing 26 in Trench/Bed Width 2 ft Manifold Trench/Bed Length zv o ft Schedule/Class yd Elevation Measurements Length 27 ft Original Drainfield Area Slope / -- % Diameter 2- in New Slope,If Altered ,'f % Preferred manifold configuration used? 1:9 0 No Depth of Excavation Up-slope j 2- '� Transport Pipe from Original Grade Down-slope Schedule/Class %O Designed Vertical Separation 2"7/ in Length !o ft Gravelless Chambers Required? al; ❑No 0 Optional Diameter 2 in Pump Required? es ❑No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day 2 �/ Diff. in Elevation Between Pump&Uppermost Orifice ! ft Dose quantity /2o gal Drainfield Squirt Height/Selected Residual(head) S ft Chamber Capacity(flood) /z-oo gal Uppermost Orifice igher 0 Lower than Pump Shutoff Pump controls:Please check Capacity those� required. ,� Capacity @ Total Pressure Head 6 7 gpm er eElapse Meter L`fEvent Counter Calculated Total Pressure Head 2/ ft If Timer: Pump on Z'.& Sir,Pump off Comments /4 r Sivs- 4.1-0 n r-/ 'DESIGN FORM—PAGE TWO Assessor's Parcel Number: Y / 1 z -- 2 -- I O O 3 0 Permit Number: SWG 10y0j ►OO 373 DESIGN CHECKLISTS Scaled of Plan Scaled yout Sketch Cross-Section Sketch e ole locations Drainfield orientation and layout Reference depth from original grade: of s D Trench/bed dimensions and DSc tank D---Prr_9perty lines cri 'cal distances within layout rainfield cover 4 �,Existing and proposed wells �' li-E /Valve box locations Reference depth from original grade within 100 ft of property eptic tank/pump chamber and restrict strata: Measurements to cuts,banks, and loca • s ® als,trench/bed,top and sur water and critical areas Obs ation port location bottom ocation and orientation of le -out location Curtain drain collector curtain drain and all absorption ifold placement Sand augmentation co�mvents Orifice lacement Other cros ction detail: ®Location and dimension of eral placement with distance Observation ports/clean-outs pri system and reserve area to ed of bed ❑ gs Other Information udi le/visual alarm referenced Yes No irection of slope indicator 0 cale of drawingshown on scale Cam❑ sin staked out je g C�W�a dines bar 0 Dint orded Notices attached • Roads, easements, driveways, 0 aiver(s)attached par • g 0 Pip curve attached orth arrow and scale drawing 0 a valuation of failure shown on scale bar Non-res. ential justification aste strength low DESIGN APPROVAL The undersigned designer must be notifi d by installer at time of installation ®des ❑ No • ature of Designer Date The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in compliance with state and local on-site regulations: vironmental Health Specialist Date CAUTION: DESIGN APPROVAL 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: 2 3 , 'Yoy j ✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval. 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Mr., 1• 4 4 A y N • 'I' i A.• .e..fn..r6:.kxx,.cVik+a*,rfr.4...r, rs.,,3r'117.t7t•r,,•:•:`.'✓14:roq..r a urea. , - 0,r i►,itA.; r►i •ra..v,+wc,:'• w..,,r,.•t F4 rA,.. .:Y.:'Y.!F4fr'f4rf+LF l .. , 2184114 MASON CO WA 07/01/2022 03:01 PM DECL DOUGLR SMYTHE #176881 Rec Fee: $204.50 Pages: 2 11011111111111111111111111111111111111111131111311111111111 Return To Douglas Smmthe 240 W. E98 Rd. D IF 1 Shelton,WA 98584-5825 JUN 3 0 2022 By J Cam" Grantor(s): (1) S/Lt y/9i'"3_ , (2) Grantee(s): (1) PUBLIC Legal Description (Abbreviated form:i.e. lot, block, plat or section, township, range) (1) /or ! SF ef get, S (sewage system, portion of) (2) Lai ; sp gm( : Aro (;)o 4'tgS (structure) Assessor's Tax Parcel: (1),.4 ( g a �- - *7 - 9 Q d O (sewage system, portion of) (2) Ail - - a 3 [Z(structure) DECLARATION OF COVENANT FOR ON-SITE SEWAGE SYSTEM I (We) the undersigned grantor(s) hereby declare this covenant and place same on record and herein, am (are)the owner(s) in fee simple of(an interest in) the described real estate above under Legal Description (1) and Assessors Tax Parcel (1) situated in Mason County, State of Washington; which the grantor(s) owns and operates portions of an on-site sewage system and drainfield or repair area that serves a structure located on the described real estate under Legal Description (2) and Assessors Tax Parcel (2) situated in Mason County, State of Washington; and the grantor(s) is (are) required to maintain the on-site sewage system in such a manner to facilitate treatment and disposal of the effluent. It is the purpose of these grants and covenants to allow easements for placement and access and to prevent certain practices that may have significant adverse impacts to the function of the on- site sewage system. NOW, THEREFORE, the grantor(s) agree(s) and covenant(s) that said grantor(s), his (her) (their) heirs, successors and assigns will allow a utility easement for the use and purpose of conveying sewage from one parcel to the other, to allow an easement for the purpose of maintaining or repairing the on-site sewage system and appurtenances thereto within 10 feet of any portion of the sewage system and to prevent practices not consistent with state and local regulations in this area. Page 1 of 2 w These covenants shall run with the land and shall be binding to all parties having or acquiring any right, title, or interest in the land described herein or any part thereof, and shall inure to the benefits of each owner thereof. Dated on this 14 day of KTutiti , 20 aa, , , Signs 4 re of k•ra % (s): --) (1) .4 rs• , (2) State of Washington ) County of Mason ) I, the undersigned, a Notary Public in and for the above named County and State, do hereby certify that on this J S'r day of S , 202Z , ootA iti.):3- Sv, -vi, ersonally appeared before me, who is known to be signer of the above instrument, and acknowledged that he (she) (they) signed it. GIVEN under my hand and official seal the day and ear last above wr' Notary Public 040"O it° State 12/29/2025 of Washington Notary Public in and for th St.V- of Washington, ARIANE M PAYSSE residing at N1ct. &Y\, Cblti as MY COMMISSION EXPIRES My commission expires: (ZI Z ZaZS , 1 Page 2 of 2 i , d i i