HomeMy WebLinkAboutSWG2022-00418 - SWG Application / Design - 7/25/2022 TH STREET
,SHELTON,WA 98584
MASON COUNTY 415 N 6SHE TON 3 0 427 9670,EXT 400
0 COMMUNITY SERVICES BELFAIR:360-275-4467,EXT 400
ELMA:360-482-5269,EXT 400
Building,Planning,Envitonmental Health Community Health
FAX:360-427-7787
On-Site Sewage System Permit: SWG2022-00418
APPLICANT DUNNING ET AL JAYLENE RENEE Phone:
4 Address: MARYLYNN WALBAUM; WILLIAM E WALBAUM BURIEN, WA 98148
OWNER DUNNING ET AL JAYLENE RENEE Phone:
Address: MARYLYNN WALBAUM; WILLIAM E WALBAUM BURIEN, WA 98148
SEPTIC DESIGNER FRANK MARCINKO -Allied Septic Phone: 360-801-0147
Design and Excavating
Address: 5677 Minnig LN NW SEABECK, WA 98380
Site Address: 2391 NE TEE LAKE RD
Primary Parcel Number: 323355000031
Permit Description: New three bdrm-pump to gravity trench with Class B waiver
Permit Submitted Date: 07/25/2022
Permit Issued Date: 09/22/2022
Issued By: Luke Cencula
Current Permit Fees Paid: $500.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 07/29/2025 (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 (9') and downslope (6") 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/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
DATE RECEIVED:
•' `. ' 't•',, MASON COUNTY as IS ' 22m. W n
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Public Health(Community Health/Environmental Health) R CO
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ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT PHONE m III
Marylynn Walbaum & Jay Dunning 206-681-4390 Z
CD
MAILING ADDRESS-STREET.CITY,STATE ZIP CODE r g
11632 18th Ave SW Burien WA 98148 . m
SITE ADDRESS-STREET,CITY.ZIP CODE xi
2391 NE Tee Lake Rd Tahuya WA 98588 I (A)
NAME OF DESIGNER PHONE D I N
Frank Marcinko 360-801-0147 m
NAME OF INSTALLER PHONE 0 I W
y I G'
PERMIT TYPE(select one) DRINKINGIN WATER SOURCE O
I1 RESIDENTIAL OSS h COMMUNITY OSS hi COMMERCIAL OSS WI PRIVATE INDIVIDUAL WELL b-PRIVATE TWO-PARTY WELL Z I v'
TYPE OF WORK(select one) a PUBLIC WATER SYSTEM
M NEW CONSTRUCTION/UPGRADES h--REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE IX REPAIR I U,
SUBMITTALS{ El SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
CD
Lit DESIGN FORM(REQUIRED) 01 SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE abbi- I o
Bp WAIVER(S)(IF APPLICABLE) 3 1 .93 Acres 0- s
DIRECTIONS TO SITE AND SITE CONDITIONS(ex locked gate) I o
North on Hwy 3 from Shelton to Belfair, left onto Old Belfair Hwy, follow to a left onto Bear 1 I o
Creek Dewatto Rd, follow to a right onto Dewatto Rd, one mile to a right onto Tee Lake Rd, r
right into driveway marked 2391. Well in clearing 1/2 way down drive on the left, soil logs ° o
are 50+ feet uphill of existing camper where there is parking. W I (J..)
—.I
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
0 17 •
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0 U - 3( BSI- p , roo-t-S I M � M6 1
ci ' JUL 2 5 2022 LIJ
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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
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
/ 1 1?I )77 3":1 7 1 % /.><" l'..S C•'* ------- IP') 114..>5
JfHI ORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSIT REVISED 12)712015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 3 3 5 — 5 0 — 0 0 0 3 1
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 ?D )''} -- C,0 K I Designer's Name: Frank Marcinko
Applicant's Name: Marylynn Walbaum&Jay Dunning Designer's Phone Number: 360-801-0147
Mailing Address: 11632 18th Ave SW Designer's Address: 5677 Minnig LN NW
Burien WA 98148 Seabeck WA 98380
City State Zip City State Zip
i DESIGN PARAMETERS
60 Cr Treatment Device
❑ Glendon Bi er San Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
0 Aerobic Unit Make/Model ❑ Disinfection Unit Make/Model Other:
Drainfield Type
( 'Gravity 0 Pressure fii'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 3034
Daily Flow: Operating Capacity 360 ale)gpd Length 200 s ft
Daily Flow: Design Flow 360 gpd Diameter 4" in
Septic Tank Capacity(working) 1200 gal Number 4
Receiving Soil Type(1-6) 4 Separation 5 ft
Receiving Soil Appl. Rate .6 gpd/ft2 Orifices
Required Primary Area 600 ft2 Total Number of Orifices -
Designed Primary Area 600 ft2 Diameter - in
Designed Reserve Area 600 ft2 Spacing - in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 200 ft Schedule/Class -
Elevation Measurements Length - ft
Original Drainfield Area Slope 8 % Diameter - in
New Slope,If Altered - % Preferred manifold configuration used? 0 Yes l 'No
Depth of Excavation Up-slope 9 in Transport Pipe
from Original Grade Down-slope i Schedule/Class Schedule 40
Designed Vertical Separation 18+ in Length 200 ft
Gravelless Chambers Required? 0 Yes 0 No fifOptional Diameter 2" in
Pump Required? EPS Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day On Demand
Diff. in Elevation Between Pump& Uppermost Orifice - ft Dose quantity 80 gal
Drainfield Squirt Height/Selected Residual(head) - ft Chamber Capacity(flood) 1189 gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head - gpm ❑Timer fi'Elapse Meter 1 'Event Counter
Calculated Total Pressure Head - MED: Pump on - ,Pump off -
Comments
SE? L 2 2022
IoNMEN�P����`
%ASUN CI IOW?C I IRG
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 3 3 5 -- 5 0 -- 0 0 0 3 1
Permit Number: SWG D') ). —o o'414
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
❑ Test hole locations g Drainfield orientation and layout Reference depth from original grade:
g Soil logs Ed Trench/bed dimensions and 0 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 g Septic tank/pump chamber and restrictive strata:
O Measurements to cuts,banks,and locations g Laterals,trench/bed,top and
surface water and critical areas g Observation port location bottom
❑ Location and orientation of 0 Clean-out location 0 Curtain drain collector
curtain drain and all absorption 0 Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
iii Location and dimension of 0 Lateral placement with distance g Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
121 Buildings liti Audible/visual alarm referenced Yes No
gi Direction of slope indicator g Scale of drawing shown on scale 0 g Design staked out
g Waterlines bar 0 g Recorded Notices attached
g Roads,easements,driveways, Bj 0 Waiver(s)attached
parking i>?f 0 Pump curve attached
10 North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be notified by install r at time of ins Ilation It Y s 0 No
Signature of Designer ate
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:
linhcbtiti
vironmental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health.
I The Onsite Sewage Permit has not expired,the Permit Expiration Date is: sui 91 • D 01 S
I Drainfield site conditions have not been altered to adversely affect conditions of deOgn 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
Spec Sheet For # 32335-50-00031
2391 NE Tee Lake Rd
1,200 Gallon (minimum) Two Compartment Septic Tank
1,000 Gallon Single Compartment Pump Tank
Install A State Approved Effluent Filter In Outlet Baffle - EF-4 Recommended
Watertight Risers To Surface On Accesses With Secured State Approved Lids
4" Double Sweep Cleanout Before Septic Tank
Liberty 290 Effluent Pump or Equivalent - Use Pump Block or Bucket/ Depll 1/r from' holesbottom at 10"
u
Redundant Off, Operational Float, And Alarm Float Required
Shutoff and Check Valve(s) Required In Pump Tank
2" Schedule 40 Transport Line Up To D-Box And 90 Degree Discharge Down
200' (linear) Of Drain Field - Four 50'Legs or Equivalent
Maximum Excavation Depth is 6" On Downslope Side To Maintain Separation
Use Gravel-less Chambers or Gravel and Perforated 3034 Pipe
Used Geo-textile Cloth Over Chambers or Gravel & Pipe
Surround D-Box In Pea Gravel - (rodent prevention) & Use Speed Levelers
SJE Rhombus Alarm/Timer/Counter/Controller Or Equivalent - On Demand Float
2 Separate 120 Volt Supply Electrical Circuits - 15 Amp & 20 Amp -
Pump On Separate Circuit From Controller '�
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0°4- .%1I,
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AP PROVED •
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