The URL can be used to link to this page

Home My WebLink AboutSWG2022-00581 - SWG Application / Design - 11/18/2022 415 N 6TH STREET,SHELTON,WA 98584 MASON COUNTY SHELTON:360-427-9670,EXT 400 4 )I' r Is COMMUNITY SERVICES BELFAIR:360-275-4467,EXT 400 V/ Building.Planning,EnvironmenWlHwllh,Community Ne rlsh ELMA: 360-482-5269,EXT 400 pi3,r,ty•• FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2022-00581 SEPTIC INSTALLER Shane Maples-MAPLES EXCAVATING Phone: 360-463-8474 Address: 911 SE Arcadia Road SHELTON, WA 98584 OWNER JAGER ANDREA & ROBERT Phone: Address: 1262 W LAKESIDE DR SHELTON, WA 98584 APPLICANT JAGER ANDREA & ROBERT Phone: Address: 1262 W LAKESIDE DR SHELTON, WA 98584 Site Address: 1262 W LAKESIDE DR Primary Parcel Number: 519015001071 Permit Description: Replace septic tank Permit Submitted Date: 11/18/2022 Permit Issued Date: 11/21/2022 Issued By: Rhonda Thompson Current Permit Fees Paid: $240.00 (additional fees may be required upon installation of system). Permit Expiration Date: 11/21/2022 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Septic Tank Only Surfacing Sewage? No Existing Failure? Yes Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 2 Drinking Water Source: Public Water System Additional Details: IM-1060 Permit Conditions: 2 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 4 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 3 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/OR 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 0DATE RECEIVED. MASON COUNTY I 1 ' t • 202 cn > COMMUNITY SERVICES AMOUNT RECEIVED:��D Q RECEIVED B CO 02 Public Health (Community Health/Environmental Health) (/� �1L��T C 415 N.6th 70,Street 56 m n,WA .ext.400 S W G /Q Z ^ ,ao ��/ (n 73 415 N.6th Street-Shelton,WA 98584 G o Z Cl) ON-SITE SEWAGE TANK ONLY APPLICATION v m n i APPLICANT PHONE m PNageir i & Andrea, lari2,r , 53- as i - 0 ycJ?- 5 z MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE S\ U W +acP2 v.1 • La ceSi(te Dr. Sigel-I-On ) WA °1g5?M ! �� Q tia2� SITE ADDRESS-STREET.CITY,ZIP CODE �O�I 1 p I-' 0-LP). W. I cU LSVk Di. S 1 ton i v i A W5V-1 V NAME OF DESIGNER PHONE 1 la NAME OF INSTALLER PHONE c, P cane Maples (Maple E vajin1' 3L,e k15- gt-litt < 0TYPE OF WORK(select one) —/ DRINKING WATER SOURCE N El NEW CONSTRUCTION/UPGRADES Q'REPAIR/REPLACEMENT ❑ PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z RI COMPONENT(S)TO BE REPLACED/INSTALLED PUBLIC WATER SYSTEM 1 Kt/SEPTIC TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE ICI ❑ OTHER d 0•y I W OTHER DETAILS(select all that apply) TAN )SETBACK CHECKLIST O 1 K S0 nil: ❑ SURFACING SEWAGE !J EXISTING FAILURE 0 SHORELINE di 100FT+PUBLIC/COMMUNITY WELLS SUiIsrALS at 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS PLOT PLAN(REQUIRED) 134ANK CROSS SECTION(REQUIRED) Lb/10FT+DRINKING WATER SUPPLY LINES ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) d 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST O ❑ PROPERTY LINES AND EASEMENTS 0 EXISTING!PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES 1 ❑ WELLS WITHIN 100FT 0 WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... JJ ❑ DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR I.-- DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) necomr (Cri old 9,T-h Curly- at nd replac , with Iecoo ineowtvr --U -, scam loativei - OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY yAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ❑COMPLAINT 0 OTHER: COMMENTS!CONDITIONS .C--12-y\NiLL Cstr(-- 16- '"L. SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS". TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS,EQUIPPED WITH RISERS AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE k k h-1 b:17 1 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 .gl I ,20up Dr _ • r/` Dra' ,, Well o o '- _ feu Decorp ryuCS'ch Oci s>?pfiG ,� rleW tot�oinfi Wr V caw\ Thal 0 00 111 ' APPROVED NOV 21 2022 MASON COUNTY ENVIRONMENTAL HEALTH ��y� RET INFILTRATOR 1 IM-1060---- septic td.r1KS Features&Benefits • Strong injection molded polypropylene .11 construction 1 • Lightweight plastic construction and e w jinboard lifting lugs allow for easy • 1:Ii delivery and handling r / ( rrens that i e #ifr'flf I interconnect with TW rises pipe riser solutions ,f (t t If 11 it gilt W IK 111( 1110 • • • • • Structurally reinforced access ports eliminate distortion during installation and pump-outs t► <. P p R 0 V Ei ifirced structural ribbing and fiberglass bulkheads offer additional '° NOV 2 1 2022strength ON COUNTY ENVIRONMENnlltaued with 6"to 48" RET of cover The Infiltrator IM-1060 is a lightweight strong and durable septic tank. • Can be pumped dry during This watertight tank design is offered with Infiltrator's line of custom-fit pump-outs risers and heavy-duty lids. Infiltrator injection molded tanks provide a • Suitable for use as a septic tank, pump revolutionary improvement in plastic septic tank design, offering long-term tank, or rainwater(non-potable)tank exceptional strength and watertightness. • No special water filling requirements Inlet Side are necessary • The tank may be backfilled with suitable TANK CUTAWAY Infiltrator _ _ native soil. See installation instructions TW Riser , ,,,.. for guidance. System-- -- s`- ', Partition ` - baffle wall- U " r HEAVY DUTY LID CUTAWAY - 1 Reinforced / 24" structural %f access port !' Structural ii ' bulkheads MID-SEAM CUTAWAY Reinforced water tight mid-seam gasketed connection s 'f • INFILTRATOR' Protecting the Environment with Innovative Wastewater Treatment Solutions water technologies 1. . . IM-1060 General Specifications and Illustrations UFTMG STRAP LIFTING LUG RISER CONNECTION (TYPICAL) (4 TOTAL) (TYPICAL) The IM-1060 is an injection molded two piece mid-seam -:.-- ---- - ��- �rl Ir) plastic tank. The IM-1060 injection molded plastic design ; �' j�1I 1 I r-'474111ii- orp �I Ni%mirk; allows for a mid seam joint that has precise dimensions A ,'i!_"-► .,i „ I 1 !,for accepting an engineered EPDM gasket. Infiltrator's t 1;=� . °% o � '� ,gasket design utilizes technology from the water industry IIC' ° 1,, °oc'��-,(; 622 ,mid*. :T�nI Osao) I to deliver roven means of maintainin a watertight seal. ,��== i i ►. �d4,,, EXTERIOR P g �� HiliwiliNijiwir;`i•; WIDTH The two iece desi n is ermanentl fastened usin a 07/15._'"E - p 9 P Y 9 t- jseries of non-corrosive plastic alignment dowels and ' ,�I-I J1 -�! i"l flocking seam clips. The IM-1060 is assembled and sold �`♦'�'�� ~ ~�� X through a network of certified Infiltrator distributors. 127.013226)EXTERIOR LENGTH TOP VIEW Must be backfilled and installed in accordance with Infiltrator Water Technologies, Infiltrator IM-Series Septic OUTLET Tank General Installation Instructions and for shallow intground water conditions reference the Infiltrator IM-Series Tank Buoyancy Control Guidance- 1 cTII s89 Please visit www.infiltratorwater.com/images/pdf/ ° (1389) .t1jy r EXTERIOR ManualsGuides/TANK01.pdf for the latest information. HEIGHT SEAM CLIP %LI r�r (TYPICAL) lIM-t060 �LIFTING STRAP `I-it1 ' V (TYPICAL) Working Capacity 1094 gal(4141 L) Total Capacity 1287 gal(4872 L) END VIEW Airspace 16.5% Length 127"(3226 mm) 04(1021 0 24(6101 ACCESS OPENINGS WITH LOCKING UDS(2) PVC OR ABS Width 62.2"(1580 mm) 0 4 I1 ozl PVC OR INLET TEE 10.2(260)FREEBOARD ABS OUTLET TEE �.,f ■■■ 1 ■■■ Length-to-Width Ratio 2.3 to 1 '6S9E -� ♦ 1 AIRSPACE I�Il OUTLET Height 54.7"(1389 mm) � I 17) ' Liquid Level 44"(1118 mm) i 44.0 FIBERGLASS (1118) FIBERGLASS 3" 6 mm) LIQUID SUPPORT Invert Drop SUPPORT(TYPICAL) DEPTH (TYPICAL) WITH BAFFLE Fiberglass Supports 2 WALL WHEREREQUIRED Compartments 1 or 2 Maximum Burial Depth 48"(1219 mm) SIDE VIEW Minimum Burial Depth 6"(152 mm) Maximum Pipe Diameter 6"(152 mm) TANK TOP CONTINUOUS Weight 320 lbs(145 kg) HALF I GASKET TANK O !E ft INTERIOR ;` � SEAM CLIP A P P V ,1 NOVNOV1 2�fl ALIGNMENT TANK BOTTOM ir 4B ass Park Road MASON COUNIO{E�rVIR`{ONM.Eh1A-HEAT-S► HALF P.O. x CT 06475 I Old Saybrook, •Fax 860-577-7001 �� MID-HEIGHT SEAM SECTION INFILTRATOIT -eoo-zz1-4aas water technologies www.infihratorewater.com U.S.Patents:4,759,661;5,017,041;5,156,468;5,336,017;5,401,116;5,401,459;5,511,903;5,716.163;5.588,778;5,839,844 Canadian Patents:1,329,959;2,004.564 Other patents pending.Infiltrator,Equalizer, ouick4,and SideWinder are registered trademarks of Infiltrator Water Technologies.Infiltrator is a registered trademark In France.Infiltrator Water Technologies Is a registered trademark In Mexico. Contour,MlcroLeaching,PolyTuff,ChamberSpacer,MuNPort,PoeiLock,OulckCut,QulckPlay,SnapLock and StraightLock are trademarks of Infiltrator Water Technologies. PolyLok Is a trademark of PolyLok,Inc.TUF-T(TE is a registered trademark of TUF-TITE,INC.Ultra-Rib Is a trademark of IPEX Inc. 0 2016 Infiltrator Water Technologies,LLC.All rights reserved.Printed In U.S.A IM02 1116 Contact Infiltrator Water Technologies' Technical Services Department for assistance at 1-800-221-4436 , Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG aBaa '0058( Parcel # 51g0I- 50 01011 Applicant Name Robert&And rm. Dv Subdivision (Name/Div/Block/Lot) Applicant Address 1 j(j IN. LUeside, Dr. LOST- L'U e1 I Dc l< 1 I Ot 11 City, State, Zip Shp1( YI, Nf A ea5gLI Installer Name M G140 I1,s Ex c v&1- b 1 q Site Address I2102 YJ• Lcukt61 t 6 Dr. Designer Name INSTALLATION CHECKLIST ❑ Full System Installation 4ank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type elf ON I ill Pretreatment Type >5 ft. from foundation? - - ❑ N/A OYES ❑ NO >50 ft.from wells? - •- ❑ [ e ❑ Z >50 ft.from surface water? - M ❑ II ❑ H Cleanout between building and tank? - - I �-L�- t;0 ❑ ❑ U Tank baffles present? - - ❑ [r ❑ f -�� 2023 _.,/ a24"access risers over each compartment I - ❑ [ ❑ W Effluent filter installed?- ET; - - - ❑ [1 ❑ • Septic tank size I Oho gal —IVfariufactu r 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO OO Manifold/D-box accessible from surface?- - ❑ ❑ ❑ mZ Check valves installed? - - ❑ ❑ ❑ oQ E Transport Line Size Schedule/Class Bedrooms installed (check one) ['2 ❑ 3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ NIA LI YES ❑ NO >100 ft. from wells?- - ❑ ❑ ❑ W >100 ft. from surface water? - - ❑ ❑ ❑ >10 ft. from potable water lines?- - ❑ ❑ ❑ Z > 5 ft.from property lines and easements?- - ❑ ❑ ❑ cx > 30 ft.from downgradient curtain/foundation drains? - - ❑ ❑ ❑ • Drainfield level and observation ports present - - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistant with septic tank? - - ❑ N/A ❑ YES ❑ NO Y Pump tank size gal anufactur r Q24" access riser(s) and accessible from surface?- - ❑ ❑ ❑ ~ Alarm or Control Panel Installed? - ❑ ❑ ❑ II. 2 Control Panel equipped with Timer/ETM /Counter- - - ❑ ❑ ❑ D a- Pump installed in ❑ Bucket or ❑ On Block Other n'• Pump Make/Model ❑ Floats or ❑ Transducer a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at qpd Updated 8'21/2018 Mason County OSS Installation Report pg. 2 Parcel# 5Ig0l -50-0I 09-I ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - [d YES ❑ NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - dYES 0 NO RECORD DRAWING This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record Drawings contain: Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines, wells,observation ports.cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits. PPROVE JAN 13 2923 MASON COLiNT y ENVIRONMENTAL HEALTH ALTH [Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I certify that I installed the system in accordance with I certify that the system has been installed in accor- the septic design stamped"APPROVED"by Mason dance with the septic design stamped`APPROVED"by County Public Health and that any deviations shown Mason County Public Health and that any deviations here have been cleared/approved by both the designer shown here have been cleared/approved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes I further certify that all information contained on this I further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. . •, 01101103 Signature of Installer Date sha,ne Maples Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: j �Q ii Lij,VLF �' 13�)- Signnvironmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8.'21,2018 RECORD DRAWING (continued) 1.-age5idc, Or. 3.8� aYwcii crIwen . zio,. , t • 4 • DeCAnmiS ion old °GefrtiC,New I0(pe 5• infiiItratDr Gaunt o‘)ts ) ri 00 liq` , e 6.1 44;04):4, °47: %fp $p, Fy y r LO St 1