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HomeMy WebLinkAboutSWG2022-00348 - SWG Application / Design - 6/16/2022 r;:,,i4--,- 415 N 6TH STREET,SHELTON,WA 98584 MASON COUNTY SHELTON:360-427-9670,EXT 400 a _,,) COMMUNITY SERVICES BELFAIR:360-275-4467,EXT 400 ELMA:360-482-5269,EXT 400 Building,Planning,Environmental IIealth,Community Health FAX:360-427-7787 On-Site Sewage System Permit: SWG2022-00348 APPLICANT BUSKALA ERIC J &TRACY L Phone: Address: 773 PATMORE RD COUPEVILLE, WA 98239 OWNER BUSKALA ERIC J &TRACY L Phone: Address: 773 PATMORE RD COUPEVILLE, WA 98239 SEPTIC DESIGNER BRAD SMITH-septic designer Phone: 253-851-2178 Address: PO BOX 1444 GIG HARBOR, WA 98335 Site Address: 391 NE TEE LAKE RD Primary Parcel Number: 323355000087 Permit Description: New three bdrm- Nuwater drip Permit Submitted Date: 06/16/2022 Permit Issued Date: 07/15/2022 Issued By: Luke Cencula Current Permit Fees Paid: $500.00 (additional fees may be required upon installation of system). Permit Expiration Date: 07/12/2025 (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. 7 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 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. OFFICIAL USE ONLY MASON COUNTY PUBLIC HEALTH DATE RECEIVED: ONSITE SEWAGE SYSTEM APPLICATION AMOUNT RECEIVED: t`jRECEIVED BY: _ a 0 415 N 6th Street,(Bldg 8) Shelton WA,98584 'J`--"—)— _ ❑_ M Shelton:360-427-9670 ext 400 Belfair:360-275-4467 ext 400 — G SWGao _- C3 --1,Z Z 2 APPLICANT,/� p r J� ir...R/S �� PHON(3(0) 7S-9- 753-z_ a 7) MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE i m -7V7: �r P r . )Z.,,,a C5 I-re z c SITE ADDRESS�p° -STREET,CITY ZIP CODE ?J o -). i/ ) I (Al - a9 39 t 0 C "'le.t. L 2 A ! I NAME OF DESIGNAERt '` PkiONE �A Li••"Ailft. % 4.)Oe ''''..) w t 5--?,,i . 2_7; ) 3,,L, J-2,)---7 .3 a NAME OF INSTALLER PHONE 9Q 6 6 CHECK ALL APPLICABLE ITEMS DRINKING UV TER SOURCE / o ❑_ NEW CONSTRUCTION ❑ RV HOLDING TANK ONLY PRIVATE INDIVIDUAL WELL < �B 0) ❑ REPLACEMENT SYSTEM ❑ INSTALLATION PERMIT ONLY 0 PRIVATE TWO-PARTY WELL ❑ TABLE 9 REPAIR ❑ SINGLE FAMILY 0 COMMUNITY/PUBLIC WATER SYSTEM z (' ❑ TANK(S)ONLY 0 COMMERCIAL SYSTEM NAME: r ❑ UPGRADE TO EXISTING ❑ OTHER: 1,A BEDROOMS LOT SIZE ❑ EXISTING FAILURE 'Record Drawing required w for all Installations" I. 4'1 ik r DIRECTIONS TO SITE-SE SPECIFIC AND ADVISE OF ANY NEEDED INFORMATIQR` OR ACCESS(ex.locked f to) �}/f ���"`��` s r aMrb Aid?---) 1 , F�.;', / 4L9 -r 0 3r YI ) -°C-. Air .�o tAE bo-04-- TMA t 44.:i' 0 '^"_....,p,,, L....A�[�91 p ) -' E 9 / ..‘,.,-,,, 12.." / r, „it 11 ' 0 SITE MUST SE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS — OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS (DC5 ... t9 ' G51.. t troot-S 0) ... v— �y N N 0 PICa • b . _'?', ODES: LC4 m V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED BY DATE 1 I 1?IfY, ��► l > , ,-5 O Z(15'70>y THIS RM MAY BE SCANNED AND AVAILABLE FOR PUBLIC ON THE MASON COUNTY WE REVISED 12/7/2015 DESIGN FORM-PAGE ONE Assessor's Parcel Number: 3 Z-3 - ---7-70 -0 0 o el A design will be reviewed when 3 conies of each of the following are submitted: 0 Completed design form that has been signed and dated. Scaled layout sketch,including all applicable items on checklist V Scaled plot plan,including all applicable items on checklist. "Cross-section sketch,including all applicable items on checklist. Thb form may be scanned and available for public view on the Mason County Web site.Maximum paper size: 11"X 17" Permit Number; SWO r '�8 Designer's Name: :rP�� S M 111A Applicant's Name: , te--• 1) IA 4 Designer's Phone Number: 21 en-- "i3 Mailing Address: T7''> I ;' 11/4-4,1(7 )'," '- Designer's Address: t '"4 Zip GNi.RA.I � State City State DESI P City Zip Treatment Device L!01end Bioftt ©S ter Ca�M LS Mound C3 Sand Lined Drainfield Q Recirculating Filter.Type: erobic Unit Make/Model 40 ❑Disinfection Unit Make/Model I. ).'( l kw_ Other: V t',-- ( . ": Drainfield Type ._.,._. .)0 Gravity 0 Pressure ❑Trench ❑Bed Sub Surface Drip____,,,/ Septic Tank/Drainfield Specifications Laterals �.___...__".._ Number of Bedrooms Schedule/Class "f" l,n,-,,,• up-1,I,,, -a Daily Flow: Operating Capacity , 10 /c_.) gpd Length 0 ft Daily Flow:Design Flow `' gpd Diameter in Septic Tank Capacity f gal Number ( 2 Receiving Soil Type(1-6) 4 Separation 1 I y ft Receiving Soil Appl.Rate „ •*.0 gpd/ft2 - Required Primary Area ( ) ft2 , Total Number of lvitlaes 0 Designed Primary Area U.:( ) ft2 Diameter , 1244ti. in Designed Reserve Area tie -' c-' ft2 Spacing \' `' in Trench/Bed Width 1 H ft Mani old Trench/Bed Length (`) ft Schedule/Class fA)L--‘:4—- Elevatfon Measurements Length I, ; --m-DW(Z 4`. ft Original Drainfield Area Slope _ % Diameter in New Slope,If Altered % Preferred manifold configuration used? ❑Yes 0 No Depth of Excavation Up-slope a - in Transport Pipe from Original Grade Down-slope a in Schedule/Class ` Designed Vertical Separation I in Length 4130 ft Gravelless Chambers Required? (0 Y Optional Diameter l J• ' in Purim Required? LYes ©No 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 !, ;;x) gal Uppermost Orific Higher Lower than Pump Shutoff Pump controls:Please check those required. ;, \ Capacity @ Total Pressure Head ( 1 spin Q°t'iiner nn 13 se Meter - Event Co1i '' Calculated Total Pressure Head �?n'�' ft If r Pump on Ie �{' 9",Pump Off ' >4.. d Comments AP PROV JUL 1 5 2022 .' EN�tNM�'N�A�-N�4 MASON COUNTY1.re� DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2- 33 5 -- — l.....✓.0 4a -7 Permit Number: SWG 71='71' ca 3y 2 S DESIGN CHECKLISTS Scd Plot Plan Sc Layout Sketch Cross-Section Sketch © 'Pest hole locationst erfrench/bed amf eld orientation and layout Referenc depth from original grade: j oil logs dimensions and ptic tank property lines itical distances within layout ( '"Drainfield cover i Existing and proposed wells ;-Box/Valve box locations Reference depth from original grade thin 100 ft of property Septic tank/pump chamber and restrictive strata: Measurements to cuts,banks,and cations 7-Laterals,trench/bed,top and surface water and critical areas ,pbservation port location bottom [ Location and orientation of ®/Clean-out location 0 Curtain drain collector curtain drain and all absorption anifold placement 0 Sand augmentation `components Orifice placement Other cross-section detail: El Location and dimension of Lateral placement with distance 0-'-Observation ports/clean-outs /primary system and reserve area edge of bed Other Information 'Buildings 0 idible/visual alarm referenced Yes No id/Direction of slope indicator ly Scale of drawing shown on scale 0 0 Design staked out <zi/Waterlines bar 0 0 Recorded Notices attached Er Roads, easements,driveways, 0 .❑ Waiver(s)attached parking E y. 0 Pump curve attached 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 must be notified by installer at time of installation Uki es . No v om , '"J Signature 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: 1 I l 5II-o YZ 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: 3Z. 0- r30 9'5 ✓ 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. 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Jt. -1r.......—J trip},frsw APPROVED JUL 1 5 2022 ivs01414--Ps MASON COUNTY `YG 1 CLIENT': gY 1C /�vJ te/ 1,, C3 6a_"74'--783z -7-73 P errm ot?._ iLici, . ovp.Jt I\ I,0(4. , ge23� SITE ADDRESS: �' I Po - L-V-- 1DATJ:s Z u PARCEL NO.: 3 Z33 S- SO —&oe IREV. DATE: PENINSULA SEPTIC DESIGNS SANDRA R. SMITH P.O. BOX 1444, GIG HARBOR WA 98335 PH#(253)8512178