HomeMy WebLinkAboutSWG2022-00633 - SWG Application / Design - 12/29/2022 l
OFFICIAL USE ONLY
MASON COUNTY PUBLIC HEALTH DATERECENED: VI 4112
4 Zah
ONSITE SEWAGE SYSTEM APPLICATION AM Wig& ' RECEIVE CO CO U)
U)
415 N 6th Street,(Bldg 8) Shelton WA,98584 villi.S < m
2
Shelton:360-427-9670 ext 400 Belfair.360-275-4461 ext 400 S,nVV'G 24.31.
3� 00433 O.- cn O
�
z cn
z DAPPLICANT PHONE >
LAURA JOHNSON 253-797-4021 m m
MAILING ADDRESS-STREET.CITY.STATE,ZIP CODE r
1543 WHITMORE WAY BUCKLEY WA 98321 c
SITE ADDRESS-STREET,CITY,ZIP CODE O
XXX HIDDEN COVE LANE LILLIWAUP WA 98555 x
NAME OF DESIGNER PHONE I CA)
CINDY WAITE 360-701-0205
NAME OF INSTALLER PHONE I lV
CHECK ALL APPLICABLE ITEMS DRINKING WATER SOURCE 0 I
❑ NEW CONSTRUCTION ❑ RV HOLDING TANK ONLY 0 PRIVATE INDIVIDUAL WELL rp I N
12 REPLACEMENT SYSTEM 0 INSTALLATION PERMIT ONLY 0 PRIVATE TWO-PARTY WELL 0
lif TABLE 9 REPAIR 0 SINGLE FAMILY ❑ COMMUNITY/PUBLIC WATER SYSTEM Z
❑ TANK(S)ONLY ❑ COMMERCIAL SYSTEM NAME 1
❑ UPGRADE TO EXISTING 0 OTHER BEDROOMS LOT SIZE I N3
❑ EXISTING FAILURE "Record Drawing required for all Installations" 2 110'X172'X112'X127' W I N
DIRECTIONS TO SITE-BE SPECIFIC AND ADVISE OF ANY NEEDED INFORMATION FOR ACCESS(ex locked gate) g 1
GO NORTH ON US 101, TURN ONTO DRIVEWAY RIGHT PAST MILE MARKER 318, I CD
STAY TO THE RIGHT, SOIL LOGS ARE ON THE LEFT SIDE OF DRIVEWAY, MARKED I o
WITH RIBBON AND ORANGE CONES. TO GO TO CABIN, FOLLOW THE DRIVEWAY
ALL THE WAY DOWN GOING TO THE LEFT. DRIVEWAY ENDS, TANK IS DUG UP AT o
FRONT OF CABIN.
R e ? ►L-
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS I CD
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(tor reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT El HOME SALE ['COMPLAINT ['OTHER:
INSPECTOR SOIL LOGS �r COMMENTS!CONDITIONS
111C� \`rt� 0 - 2- 51, r 7X
C % 9 20.2 ! h/ I(✓ ' dtr 1
DE tJ - 1 /✓
A/0 I,)
\N
LoC\h`. e
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS
I P CTOR SIGNAITURE DATE APPLICATION EXPIRATION DATE [CATION APPROVED BY ^ATE
c lv J A,Lof1 \5-� -3 1- s--2 '( (���'VU�
) I'/0 Z3
TH F MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBS( REVISED 12/Ti20t5
MASON COUNTY 415 N 6TH STREET,SHELTON,967 ,WA 98400
SHELTON: 42 EXT, 400
584
BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2022-00633
APPLICANT JOHNSON LAURA M Phone:
Address: 1543 WHITMORE WAY BUCKLEY, WA 98321
OWNER JOHNSON LAURA M Phone:
Address: 1543 WHITMORE WAY BUCKLEY, WA 98321
SEPTIC DESIGNER CINDY WAITE-Septic Designer Phone: 3607010205
Address: 80 E PICKERING LANE SHELTON, WA 98584
Site Address: N Hidden Cove Ln
Primary Parcel Number: 324242200160
Permit Description: Repair -2BR Glendon
Permit Submitted Date: 12/29/2022
Permit Issued Date: 01/10/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $740.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 01/05/2026 (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: masoncountywa.gov/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 4 2 4 — 2 2 — 0 0 1 6 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 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: II",%17"
PARCEL IDENTIFICATION
Permit Number: SWG -2°),2—CO6, 3 Designer's Name: CINDYWAITE
Applicant's Name: LAURIE JOHNSON Designer's Phone Number: 360-701-0205
Mailing Address: 1543 WHITMORE WAY 80 E PICKERING LANE
Designer's Address:
BUCKLEY WA 98321 SHELTON WA 98584
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device •
'Glendon Biotilter ❑Sand Filter 0 Mound ❑Sand Lined Drainfield ❑ Recirculating Filter.Type:
0 Aerobic Unit Make/Model ❑ Disinfection Unit Make/Model Other:
Drainfield Type
0 Gravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class GLENDON MODULES
Daily Flow: Operating Capacity 180 gpd Length
ft
Daily Flow: Design Flow 240 gpd Diameter
in
Septic Tank Capacity 1200 gal Number
Receiving Soil Type(1-6) 4 0
20
ft
Receiving Soil Appl. Rate .6 <.z,
gpd papoR dices
Required Primary Area 424 ft2 Totgntp�q o ,Qrces STAND PIPE
Designed Primary Area a 400 •2 MASON [DULL
ro' E`NVIRONMENTAL H i 1
1
Designed Reserve Area 400 ft-' SpacingJ8 EALTH
'french/Bed Width 14 ft
w in
Manifold
Trench/Bed Length 18 ft vch,j le/Class FLOW SPLITTER
i
Elevation Measurements "I'QL.eng '4# AS PER GLENDON ft
Original Drainfield Area Slope 5 % r ��,�1
a' E1CI�I�, 1eV SOP in
New Slope, If Altered 0/��P~ r ..i'l' ? c •i ify� figuration used? 0 Yes 0 No
Depth of Excavation Up-slope Ark, 1 s tr�'
from Original Grade �;Ler,:5tO V' �11 Transport Pipe
nO��,-tiione eir , t C. ash 11 SCHEDULE 40
Designed Vertical Separation Xift �E DESIGNER i/
tn1,44±,fk . ,1, 80-90 ft
Gravelless Chambers Required? 0 Yes 0 No 0 OptionEtYiniameter
2 in
Pump Required? ❑ Yes ❑No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day PER GLENDON SOP
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity PER GLENDON SOP
Orifice 10 ft gal Qt
Chamber Capacity 1200 gal \\
Uppermost Orifice 0 Higher Its Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head PER GLENDON SOP gpm se Meter
Pirr [Timer p GiEvent Counter
Calculated Total Pressure Head PER GLENDON SOP ft If Timer: Pump on Pumpoff
Comments
SEPTIC AND PUMP TANK MUST BE CONCRETE, PUMP CONTROLS PER GLENDON SOP,
FOLLOW GLENDON INSTALL MANUAL
Se.e pile- 7 f/(.4 .6
No wo(tJPxr b1 Ai; I '1 i/ G4r4,..10w4
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 4 2 4 — 2 2 -- 0 0 1 6 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
66 Test hole locations 67! Drainfield orientation and layout Reference depth from original grade:
g Soil logs g Trench/bed dimensions and I' Septic tank
g Property lines critical distances within layout 0 Drainfield cover
Vi Existing and proposed wells g D-Box/Valve box)locations� Reference depth from original grade
within 100 ft of property li4 Septic tank/pur!p cl5am r and restrictive strata:
IZ Measurements to cuts, banks,and locations ply ) Mom Eir Laterals,trench/bed,top and
surface water and critical areas It Observation port location bottom
reit --eitt Location and orientation of lig Clean-out location Nl.- • 0 Curtain drain collector
curtain drain and all absorption g Manifold placement mil•- 0 Sand augmentation
Mk components Orifice placement Nl v Other cross-section detail:
g Location and dimension of Lateral placement with distance g Observation ports/clean-outs
primary system and reserve area to edge of bed A✓Iav
Buildings / Other Information
g Audible/visual alarm referenced Yes No
ifl Direction of slope indicator It Scale of drawing shown on scale It 0 Design staked out
g Waterlines bar 0 0 Recorded Notices attached
It Roads,easements,driveways, 0 0 Waiver(s)attached
/parking 'e 7"1kP" 1 0 0 Pump curve attached
11 North arrow and scale drawing (.. 1-g ❑ Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must b tified b installer at time of installation RI Yes 0 No
/� ��__ / 2 /2iZZ
Si ture of Desi 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-s. egulations:
(,,)� /..-/O 23
Env' o �!al Health Specia ist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
V The design is stamped"Approved"by Mason County Public Health.
V The Onsite Sewage Permit has not expired,the Permit Expiration Date is: /—
.512
/
V Drainfield site conditions have not been altered to adversely affect conditions of design approval. 1 y k
Please Note: The system must be installed by a certified installer,
unless prior authorization is obtained from Mason County Public Health.
An Installation Fee wail.--
This form may be scanned ahilibl=r' IF c f E. the Mason CountyWeb site.
JAN 10 2023 Updated Date: I2/7/2015
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
2a' r
` /0 fie., ---_
1
,t0 Epsfi''f Gabi.1
,a , Q u1io 1 ,,„iv,,/ al at.,
€'14a)W
-r 0 l eeN of
r
��08 C0/` de
,01
$ S
4 (101 40 le. th4
A Rate
7 p Tea
Lev'
J
'� w v G i:h:
Pal(
t r) ‘,\ , (___.7. -----1.. ..
6 1-,
, GE -). ro) 44-
. 610,Aki e)'' 6iedi"s " \ *.ree
Ohl eat 4
121/4/ )/' n ito
S-ee Pag e
\ 1 I*4
\
.'''i, 0 SL 1 0-l2, L
110 i
. tt l)'� (,,,, vi
Ar;. ' k.,,. qr--"Ii ' . , , A I.
�we ! „a .. � r�,r _ In
JAN 102023
exiHts �s ENVIRONMENTE
JawAC HEALTH
?2- y1y- 22- oG t
r
!-- - /.,
I.
N'
1 i I
6 ' .
I
(N'
` j
`f/ / Ii = asL_ 3vC�ssti = ) 12a14Z
Z 11,2.yg
AP P R 0 V .. 4.4 Al vcrs-90 C' � c,
13.
/3AN 1 0 2023 ,
MASON COUNTY ENVIRONMENTAL HEALTH
Jaw e
(1:5" vfqs9 �Q., ,tel
JJJn
5 0
`\, ITEptiCt VA.' DESIGNER:
PAGE 3 OF.L7`
Glendon 8iofil ter Design Checklist
' REQUIRED: DESIGNED:
1.Morn Vertical Separation: 12'+ 121+
2 &xhnwn Ground Slap.: 20%or less Ok
'&Basin Capacity:2.2113 per gallon of waste per day
#bedrooms x 120 x 2.2=ft3 of basin volume
required SZ r God
4.Rim Length: #becttoonts x 12Q
ran
5.A l tion Ants:
4 �� f
� qf
bedn+oorns x� 11.5 Gj� �� �2
4/
0. Basin Utter: 30 mil PVC OK
7. Ground Slop.-vs-AbaorpUon Ann:On slopes
greater than 5%only the dawnslope perimeter and%
of the side perimeters are useable for rim length and
& Setbacks ROM i,Gleindon MN*: Must conform to
WAC 246-272 OK
for mound
Weems .
A influent Miastowafer Sbsnglh: Must be typical
of domestic OK
* household
_ sewage
APJPNO!ZED
4.1A Ne0t1NTY z F,>s -7, \/�,o
ENVIRONMENTALH �� ���~ �`�� (�' �kI1
JBw HEALTH
1 5100 ',.
p- 1NDY . TE
LIC S DE NER
LxPutLS u5,10,
(" :. i�� ie C • ' •' g', �_ / :`":1i�,•,op I County MS
1
I
SECURED LID WITH GAS TIGHT SEAL
/
24"DIAMETER
ACCESS RISER \
Illmiiiiimmuil FINISH GRADE
(lIL ''
/ • - TO PUMP
c CHAMBER
FROM SEWAGE / ~
SOURCE FLOATING MAT
_ APPROVED
EFFLUENT
FILTER
SEDIMENTS
I SEPTIC TANK
(TYPIGAI)
SECURE9),ID WITH GAS TIGHT SEAL
THREADED UNION
/ 24"DIAMETER
ACCESS RISER
FINISH GRADE - -� SERVICE
VALVE*
I C\
lk
FROM SEPTIC I I2 -1-" �:j,
TANK II ►TO DRAINFIELD
vii__ ri
} IIIII
EMERGENCY STORAGE
"�
ANTI SIPHON
HIGH WATER ALARM LEVEL + VALVE*
I
WORKING VOLUME I INDEPENDENT
NORMAL TIMER OFF LEVEL + I
FLOAT STEM
—^Q FOR FLOAT
ENCLOSED PUMP • MOUNTING
SEDIMENT SHROUD* AEI CHECK VALVE"
SEDIMENT-TS 18 SUBMAR816LE
-le grI CENTRIFUGAL
II PUMP
PUMP C BER i I
(TYPICAL) I r ti -.P(1.• •IAppRoVE
.,k,.').
JAN 10 2023
olasaN eauN ENVIRONMENTAL yEA'' ;4� oi:. yy9 . N E ED iV /
\
�
0 18\'� IIO Dv WqE ,
\f
k
' L`C"'1c6D WS,GAI r[;H kibMitAblom . .... h,Jgy EXPIRES osno/
Installation Notes
Pressure Distribution System:
571 SE Totten Shore 22031-50-00024
1. This is a failed on-site system. System installed in 1966. Tank has been pumped,
drainfield not accepting water. Copy of maintenance report attached.
2. Power, water and all utility lines must be located prior to installation.
3. The existing septic will be decommissioned.
4. Concrete tanks required.
5. Installer must follow Glendon Installer Manual
IK 6. There is a 4" pipe coming across the driveway, it is marked with a ribbon, about
ten feet from driveway. Will required this to be tightlined to below the glendon
modules.
7. The tanks may be moved as necessary to accommodate building requirements. Septic
tank location must meet all required setbacks.
8. Keep wheeled vehicles off the drainfield area before, during and after installation.
Tracked equipment only,
9. All ground, surface water and roof drains must be diverted away from the septic tanks
and drainfield. Ensure the final grade slopes away from these areas and water doesn't
collect on or around them. Use swales, berms, catch basin and tight lines, curtain drains,
etc. to divert all waters.
10. Curtain drains can be no closer than 10' upgradient and 30' down gradient of the
drainfield
11. Exposed restrictive layers, cuts, banks, etc. can be no closer than 50' downhill from the
drainfield.
12. Install access risers on the septic tanks, valve box and ends of laterals.
13. Make sure septic tank risers are epoxied or caulked to cast in riser rings on tank.
14. Lids must form a vyater and gas tight seal with the access risers
d 15. Install effluent filter specified in this design at the septic tank outlet.
16. This system must be installed by a Mason County Certified licensed installer and an
approved Glendon installer.
17. Deviation from this design without prior approval from the designer and Mason County
Health Department will make this design null and void.
18. This design was sized per Washington Administrative CodeWAC246-272A-0230. The
operating capacity is based on 45 gallons per day per capita with two persons per
bedroom. The minimum design flow per bedroom per day is the operating capacity of
ninety gallons multiplied by 1.33. This results in a minimum design flow of one hundred
twenty gallons per day. This creates a surge factor of 33% but anticipated flow is ninety
gallons per bedroom per day. i,
19. Install audio/visualalarm �•1I
• e1
P p R ' '
EVE � 1 titi
A
JAN 10 2023 VIP
r - z �1 1 a
MASON-COUNTY 0 Co
. s/
ENVIRONMENTAL HEALTH a CINDY E QWAITE 18 �`7 1
JBw LICENSED DESIGNER 1/
AWL igha IIM MIL ����MI
EXPIRES 05/10,
r
System Owner Responsibilities:
1. Glendon systems require annual maintenance by a Mason County Maintenance
Provider.
2. Operation and Maintenance is required by Washington State Department of Health and
Mason County Health Department.
3. The septic tank and pump tank should be pumped every three to five years or as
needed.
4. System owners are responsible for having maintenance performed annually.
5. System owners are responsible for responding to septic issues in a timely manner.
6. System owners shall not at any time change or alter settings in the control box.
7. System owner agrees to read and abide by information regarding their system in the
User Manual provided by Mason County Public Health.
8. Keep the flow of sewage at or below the approved design operating capacity.
9. Keep waste strength at residential waste strength parameters.
10. Spread loads of laundry through the week.
11. Do not use excessive bleach or detergents with added whiteners.
12. Do not shower, do laundry and dishwasher at the same time
13. Antibiotics can kill or impair the biological process in the septic tank.
14. Leaky plumbing can hydraulic overload your on-site septic system.
e)4) /111/
ngy 9��i l,e X
PPR 0 .tom
•
EV 100418
��� � 0 �� O� CINDY E WAITE
MASON ,+ �`
LICENSED DESIGNER
13
COUNTY ENVIRONME EXPIRES os,o,
NTgL HEALTH
JBW
Bamford septic Repa/r,LLC
301 E. Wallace Kneeland Blvd STE#224-332 136079022E4
Shelton, WA 98584
PROPERTY INFORMATION
Location:N US HIGHWAY 101
Lilliwaup
Tax ID 324242200160
BRADFORD D SCHAFER
8578 SW SHAD RD I Use.
TERREBONNE,OR
97760 GENERAL SYSTEM TYPE:Conventional (Non-Pressurized)
ON ID:324242200160
County Area: Hood Canal MRA(w/in 1100 ft)
ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT — r- .
Inspected:11/25/2022 - Inspection Type:PROPERTY SALE - Correction Status:No corrections made
•r.:p.rny Wish Performed By' Submitted 11/28f2022 by
( Bamford septic Repair,LLC Thaddeus Bamford Thaddeus Bamford
COMMENTS 8 GENERAL INSPECTION NOTES
Deficiencies Noted:deficienr;ies must be corrected to ensure proper longevity of the Onsite Sewage System.
Exposed outgoing line to drain field. Ran water to field with garden hose Drain field not accepting wale'
Recommend replacing.Contai.l Du,igtie . Dug•1 pore holes 1 by old dram field in front of deck 3 above cabin flagged with pink ribbon
GENERAL SITE&SYSTEM CONDITIONS
The General Site and System Conditions were dull,Inspected
Components accessible for servers. YES
All required service.performed(if no-specify omitted inspection items in dotes) YES
Surfacing effluent from any component(including rnouno seepage). NO
Components appear to be watertight-no visual leeks YES
Improper encroachment(structureslimperviuus surfaces)_ NO
All riser lids securely fastened upon departure N/A
Electrical repairs needed. If YES describe in comments' NIA
Root intrusion on any components. If TES describe in comments NO
Settling problems observed If YES delscribe in comments: NC)
The nouserstructure was vacant or used infrequently,assessment of the orainfietd was not possible NO
ONSITE SEWAGE SYSTEM INSPECTION DETAIL
eistrlbution:0-Box
?•'•.c.ornponent was. .__—_ Not Inspected
,n;Mort conntlion N'A
U-Box outlets set to allow equal effluent distribution NA — --.
ANK:Septic Tank-I Compartment
This component was: Partially Inspoctud
Effluent level within operational!snits(if NO explain in comments)
All required baffles in place MIA-No baffles required)
'Compartment 1 Scum accumulation(Inches,if other specify)
(Compartment 1 Sludge accumulation(Inches,if other specify):
;Pumping recommended. NO
grainfield(disposal):Gravity
This component was. Fully Inspected
'Component appears to be functioning as intended
NO Uri+.r .t
'Ponding present?If YES explain in comments: - YES I;,'::,•^.
IDrainfield was vacuumed,flushed or hyitro-jetted?(If YES,explain in comments) No
\Ck
cnmartenares or tn+,re+.mA snertgc..ysmm at ta.me,,1,,,ax fn rro war rs gua.aporr a guarantee a.npr anon tr hdWe r'a't-,,adr.r.
ReportlD:1134317 View inspection reports online at www.ontinerme corn Page 1 of 1