HomeMy WebLinkAboutSWG2022-00504 - SWG Application / Design - 9/26/2022 I j
OFFICIAL USE ONLY
DATE RECENED:
MASON COUNTY oL . r _ N
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COMMUNITY SERVICES AMOUNT • � DB: Wv co
Public Health(Community Health/Environmental Health) N
360427-9670,ext 400 a 360-275-4467,ext.400 I
475 N.6th SOee,-Shelton.WA 98584 1 SWG
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ON-SITE SEWAGE SYSTEM APPLICATION 3
APPLICANT PHONE m m
Bob Abelson (360) 432-1921 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE
141�DE. Deer Creek�DRd. Shelton WA 98584 - m
SITE -STREET,CITY ZIPCA) •
Mason Lake Rd. Shelton WA 98584 I c'
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NAME OF DESIGNER PHONE I N
Dale L. Tahja (360) 426-5940
NAME OF INSTALLER PHONE I
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PERMIT TYPE(select one) DRINKING WATER SOURCE W ii RESIDENTIAL OSS b COMMUNITY OSS Fri COMMERCIAL OSS a PRIVATE INDIVIDUAL WELL Ll PRIVATE TWO-PARTY WELL Z I
TYPE OF WORK(select one) ❑ PUBLIC WATER SYSTEM
8j NEW CONSTRUCTION/UPGRADES ij REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I fV
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
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RI-DESIGN FORM(REQUIRED) r-SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE I W l-7 WAIVER(S)(IF APPLICABLE) 4 8.11 acres o
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
Go to McEwan Prairie and Mason Lake Rd. junction, turn left, go towards Mason Lake, first ( I o
driveway on the right. Locked gate, call Bob Abelson @ (360)432-1921 to schedule r I 0
inspection. -I
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED*TM TEST HOLE NUMBERS. I iJj C P 2 3 2022 i-- o
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(tor reporting purposes) — 1. 4M
El VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER: -+� 0
INSPECTOR SOIL LOGS r. COMMENTS/CONDITIONS +�S�-�P ; 00
Ofor
..-- 5° 47r 1 ..fro -
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,tip sy . <.;1,;;T.
RECORD ORAIMNG AND INSTALLATION REPORT ilk 1
SOIL CODES: 4,
V=VERY G-GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINALAPPROVAL
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE AP.PCI ATION APPROVED/ISSUED BY DATE
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,\ ; , 10.ak 2: ijc`' - („Ilk 10 '31-2L
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OORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
� 415 N 6TH STREET,SHELTON,WA 98584
MASON COUNTY
SHELTON:360-427-9670,EXT 400
a I. COMMUNITY SERVICES BELFAIR:360-275-4467,EXT 400
; ELMA:360-482-5269,EXT 400
1* Budding,Planning,Emir onmental Health,Community Health FAX:360-427-7787
On-Site Sewage System Permit: SWG2022-00504
APPLICANT ABELSON ROBERT A&SALLY A Phone: 360-432-1921
Address: 141 E DEER CREEK RD SHELTON, WA 98584
OWNER ABELSON ROBERT A&SALLY A Phone: 360-432-1921
Address: 141 E DEER CREEK RD SHELTON, WA 98584
SEPTIC DESIGNER DALE TAHJA-Septic Designer Phone: 360-426-5940
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: UNKNOWN
Primary Parcel Number: 321342390030
Permit Description: NEW SFR -4BR Sand lined bed
Permit Submitted Date: 09/26/2022
Permit Issued Date: 10/31/2022
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $740.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 09/26/2025 (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 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.
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 1 3 4 — 2 3 — 9 0 0 3 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 20).1.-005 04 Designer's Name: Dale L.Tahja
Applicant's Name: Bob Abelson Designer's Phone Number: (360)426-5940
Mailing Address: 141 E.Deer Creek Rd. Designer's Address: 2450 W. Deegan Rd.W.
Shelton WA 98584 Shelton WA 98584
City State Zip City State Zip
; DESIGN PARAMETERS
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound @'Sand Lined Drainfield 0 Recirculating Filter,Type:
0 Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
❑ Gravity lif Pressure 0 Trench 11 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4 Schedule/Class Sch. 40
Daily Flow:Operating Capacity 360 gpd Length 48 ft
Daily Flow:Design Flow 480 gpd Diameter 1.25 in
Septic Tank Capacity(working) 1,200 gal Number 3
Receiving Soil Type(1-6) 1 Separation 3.33 ft
Receiving Soil Appl.Rate 1.0 gpd/ft2 Orifices
Required Primary Area 480 ft2 Total Number of Orifices 81
Designed Primary Area 480 ft2 Diameter 1/8 in
Designed Reserve Area 480 ft2 Spacing 21 in
Trench/Bed Width 10 ft Manifold
Trench/Bed Length 48 ft Schedule/Class Sch.40
Elevation Measurements Length 6.6 ft
Original Drainfield Area Slope 3 % Diameter 2 in
New Slope,If Altered 2 % Preferred manifold configuration used? 0 Yes gi!(No
Depth of Excavation Up-slope 48 in Transport Pipe
from Original Grade Dowr,_slope 45 in Schedule/Class Sch.40
Designed Vertical Separation 24 in Length 15 ft
Gravelless Chambers Required? 0 Yes 0 No 6i'Optional Diameter 2 in
Pump Required? Ft Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 4
Diff.in Elevation Between Pump&Uppermost Orifice 6 ft Dose quantity 90 gal
Drainfield Squirt Height/Selected Residual(head) 6 ft Chamber Capacity(flood) 1,200 gal
Uppermost Orifice 6t'Higher ❑Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 38 gp T r 7 r;"-4Elapse Meter C�Event Counter
Pressure Head 16 ft a 1 Tr. :' un o ; `;2:$min. pump off 5 hrs 57.7 min
Calculated Total44
.` UCT 3 1 2022 '
Comments < ,
MASON COUNTY ENVIRONMENTAL HEALTH
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DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 1 3 4 — 2 3 -- 9 0 0 3 0
Permit Number: SWG
DESIGN,CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
0 Test hole locations Gd Drainfield orientation and layout Reference depth from original grade:
RI Soil logs It Trench/bed dimensions and g Septic tank
0 Property lines critical distances within layout Q( Drainfield cover
Ed Existingand proposed wells Pi D-Box/Valve box locations
P P Reference depth from original grade
within 100 ft of property lg Septic tank/pump chamber and restrictive strata:
Elf Measurements to cuts, banks,and locations E21 Laterals, trench bed,top and
surface water and critical areas RI Observation port location bottom
Pi Location and orientation of fill Clean-out location 0 Curtain drain collector
curtain drain and all absorption 54 Manifold placement fib Sand augmentation
components Ct Orifice placement Other cross-section detail:
Location and dimension of El Lateral placement with distance 11 Observation ports/clean-outs
primary system and reserve area to edge of bed
0 Buildings Other Information
Eil Audible/visual alarm referenced Yes No
6� Direction of slope indicator Elf Scale of drawing shown on scale d 0 Design staked out
RI Waterlines bar 0 0 Recorded Notices attached
E4 Roads, easements,driveways, ,>'=. IY" ` }' 0 0 Waiver(s)attached
parking 5 ' 0 Pump curve attached
lid North arrow and scale drawingOCT3 0 Evaluation of failure
shown on scale bar N/.ASON CO(1 N T ' 2uc2 Uon-residential justification
1 ENVIROVMENTq ❑ ❑ Waste strength
` a Ili/ HEAL 40 ❑ Flow
DESIGN APPROVAL
The undersigned designer m st be notifie i iv to er at time of installation l4 Yes 0 No
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Signature of Designer \ Date 4:.�,,�e: .,.
C- , 01.
',7-" rx 1,
The undersigned has reviewed this design on behalf of Mason County Public Health and dete a";. 1 e. , • ' 0
compliance with state and local o -si a regulations: ++: 3:st `"" Q
E in tal Health Specialist Date �>t ' ` z
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDIIv4�' —
✓ The design is stamped"Approved"by Mason County Public Health. it 1
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: 10 L `Z 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.
Updated Date: 12/7/2015
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