HomeMy WebLinkAboutSWG2021-00364 - SWG Application / Design - 6/17/2021 (2) MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
J BELFAIR:360-275-4467,EXT 400
i 3 Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2021-00364
APPLICANT RODGERS BRYTON M Phone: 360.490.1557
Address: 11 SE FERNWOOD LN SHELTON, WA 98584
OWNER RODGERS BRYTON M Phone: 360.490.1557
Address: 11 SE FERNWOOD LN SHELTON, WA 98584
SEPTIC DESIGNER Jim Hunter and Associates Phone: JIM 360-507-1265
Address: PO Box 162 OLYMPIA, WA 98507
Site Address: UNKNOWN
Primary Parcel Number: 220291490032
Permit Description: New four bdrm-gravity bed (revision)
Permit Submitted Date: 06/17/2021
Permit Issued Date: 06/28/2021
Issued By: Luke Cencula
Current Permit Fees Paid: $635.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/22/2024 (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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
f
V...e.d, 9) oci
•OFFICIAL USE ONLY -
MASON COUNTY PUBLIC HEALTH DATERLIF,ry'ED. 4 17 _ a i
ONSITE SEWAGE SYSTEM APPLICATION AMoVMR SO RECEIVED pp 0)
415 N 6th Street,(Bldg 8) Shelton WA,98584 4r TlT� 0
Shelton:360-427-9670cxt400 8elfzir:36C275-4467ext400 SWG ��� ` p
VV sita44 „
Z -o
APPLICAN' I PHONE D D
BRYTON RODGERS 360 490-1557 m m
MAILINGADDRESS-STREET.CITY,SATE ZIP CODE r
11 SE FERNWOOD LN SHELTON WA 98584 z
SITE ADDRESS-STREET CITY.ZIP COUE W
SHELTON WA 98584 m
NAMF OF DESIGNER 'HONE
JIM HUNTER 360-753-1226
NAMF OF INSTALLER PHONE -
- 1:3 IC.
CHECK ALL APDLICABLE I I EMS DM I.lG 'WATER SOURCE
C
(p
d NEWCONSTRUCTION ❑ RV HOLDING TANK ONLY PRIVATE INDIVIDUAL WELL b)
❑ REPLACEMENT SYSTEM ❑ INSTALLATION PERMIT ONLY 0 PRIVATE TWO-PARTY WELL Z :
❑ TABLE 9 REPAIR gr SINGLE FAMILY 0 COMMUNITY/PUBLIC WATER SYSTEM
❑ TANK(S)ONLY 0 COMMERCIAL SYSTEM NAME: I 11
❑ UPGRADE TO EXISTING 0 OTHER- BEDROOMS i.O'SIZE
❑ EXISTING FAILURE "Record Drawing tetrad for an installations" 4 3.03 W
-.
11
DIRECTIONS'O SITE-6E SPEGFIC AND ADVISE OF ANY NEEDED INFORMATION FOR ACCESS(ex locked gate) 0 I
1,:4 1.44. � fly-�-r o� J th?-41.-1 Wk 144- '( C-L 0 - ,a& .. ', C x
L -r 1 ID
r 10
Ifui
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS I5-)
' OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOU iCF(for reporting p:rpeses)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE OCOMPLAINT ❑OTHER:
IN SPEC ION SCXI I OGS COMMENTS I CTRJUI IIONS
6 v - lid d 6 i-i5 ,f1 S , re,eI- -t y
tip S r vn..l a-.. t
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L..LOAM SI=SILT C=CIAY E=EXTREMELY R-ROOTS
INSPECTOR SIGNATLRE DATE APPLICATION EXPIRATION DATE APDLICAAT ION
fAPPROVED BY DATE
ORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSiTE 111111.
REVISE-0 1272CT5
*nnted From Mason County .: ,
Printed rOi M sot CountyOMS
DESIGN FORM—PACE ONE Assessor's Parcel Number:oR.2. as4 -- f 4 _ 0 C;
A design will he 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: I I .X/7"
PARCEL IDENTIFICATION
Permit Number: SWG. ?'I — 00 3 6/ Designer's Name: JIM HUNTER
Applicant's Name: BRYTON RODGERS Designer's Phone Number: 3ti0 753 1226
Mailing Address: 1 1 SE FERNWOOD LN PO BOX 162
Designer's Address:
SHELTON WA 98584 OLYMPIA WA 98507
City State Zip City State Zip
DESIGN PARAMETERS
'_ C.->P Treatment Device
0 Glendon B jc iltcr laid Filter 0 Mound 0 Sand Lined Drainfield ❑ Recirculating Filter.'Tyne:
)P
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
WiGravity ❑Pressure ❑Trench ffYied ❑Sub Surface Drip
Septic Tank/Drainfield Specificadons
Laterals
Number of Bedrooms 4 Schedule/Class 200
Daily Flow:Operating Capacity 3 La 0 gad Length 60
ft
Daily Flow:Design Flow 4 B 0 gad Diameter 4
in
Septic Tank Capacity 1,250 gal Number 4
Receiving Soil Type(l-6) 3 Separation
t•S ft
Receiving Soil Appl. Rate 0.8 gpd/fI2 Orifices
Required Primary Area Lt.J 4 112 Total Number of Orifices N/A
Designed Primary Area 40 o ft' Diameter N/A
in
Designed Reserve Area (.4,0 0 ft Spacing N/A
in
Trench/Bed Width 10 ft
Manifold
Trench/Bed Length 60 ft Schedule/Class 200
Elevation Measurements Length —1. S ft
Original Drainfield Area Slope 0 % l)iameter q
in
New Slope,If Altered 0 _ `% Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation UP•slopc 2 4. in ,i
from Original Grade Transport ripe
lkown-slope 24 " in Schedule/Class 200
Designed Vertical Separation 36 in Length 50
ft
Gravclless Chambers Required? 0 Yes if No ❑Optional Diameter 4
_ in
Pump Required? 0 Yes fiilNo Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day N/A
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity N/A
Orifice WA ft gal
Chamber Capacity N/A gal
Uppermost Orifice 0 Higher ❑Lower than Pump Shutoff Pump controls: Please check those required.
Capacity(2 Total Pressure Head N/A gpm ❑Timer ❑Elapse Meter 0 Event Counter
Calculated Total Pressure [lead kt, +1, ' M ter: Pump on N/A ,Pump ofT N/A
Comments
JUN 2 8 2021
Printed From tviascianifiAtritMntr4PftoeirAp .
pri ntM.d from t,i•m,on Cox..1My OMS
AO `,..eratte.roef
DESIGN FORM-PAGE TWO Assessor's Parcel Number•: _1.3 -- _L -- () by 5 a
Permit Number: SWG_ 2-'► - 003 toi
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
❑ Test hole locations 0 Drainfield orientation and layout Reference depth from original grade:
❑ Soil logs 0 Trench/bed dimensions and ❑ Septic tank
❑ Property lines critical distances within layout 0 Drainfield cover
O Existing and proposed wells 0 l-Rox/Valve box locations Reference depth from original grade
within 100 ft of property ❑ Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts, banks, and locations 0 Laterals,trench/bed,top and
surface water and critical areas 0 Observation port location bottom
❑ Location and orientation of 0 Clean-out location 0 Curtain drain collector
curtain drain and all absorption 0 Manifold placement ❑ Sand augmentation
components 0 Orifice placement Other cross-section detail:
❑ Location and dimension of 0 Lateral placement with distance 0 Observation ports/clean-outs
primary system and reserve area to edge of bed
❑ Buildings Other information
❑ Audible/visual alarm referenced Yes No
❑ Direction of slope indicator ❑ Scale of drawing shown on scale 0 0 Design staked out
❑ Waterlines bar 0 0 Recorded Notices attached
❑ Roads,easements,driveways, 0 0 Waiver(s)attached
parking 0 0 Pump curve attached
❑ North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
O 0 Waste strength
❑ ❑ Flow
DESIGN APPROVAL
'l'hc undersigned designer trust be notified b '''• rinstallation ❑ Yes No
tsf�r... (a -l•to-.2-1
Signature Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to he in
compliance with state and local on-site regulations:
Gil (-3d-2_3
rvironmci al th Specialist ' T
t1)atc
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
V "1'he design is stamped "Approved"by Mason County Public Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:. VL-L ")",..›CYT1
• 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.
s� Updated Date: 12i712015
.t 3 i“ 2 h k..iC 3xt '< t a ' a i R} it S n IN y
Fz st c.a-,,... �i x _ .: fn... �,�.',.:.s . ��:, '.. �cNx 1 .s..,c�:.�,� k..''
t 8 O
J
w
x
$)0 w Z
r .'T_►l J § O$
MM o
......''' 'N\----:1
ID
rsi
rn
CL
co
r a. I ; ! i,•!^ . 7r z 0 H Q = (n Z N 0
' !0 11.. ) 3 III
, U) i>7 --)
• G Y- I , i�• Z p ' W '
U.
I� I I 4I ,9f I :,; r. 5
! ;
'LJ
N1,1111111bp. I <
. . . 7 Z 4s! ' U-
il v,‘ :7
\ 1,• . ' e; : , .4, el =
, , , . 0 et , , . .
fi - �`., fi,„ JJ m
J . LI: 17i .. : re -'..4: §.
A P
4 I` I • 3J Q' Q
rev T
0
. . vi :01-.1 _. 1,. ___ 1 ii. 1-1 .,,, ;o
6
,. p), , , : ,, 01 ,v). ,.../
a 0 a _
< ; ; 4 ,g il ; - ice
7 p(��,, A i i i j { oni .
i
C � 1 cJmr- � vim
6
c"..N.,... \....,7".. .......•••• ....7"....7 -....... .:..."-3:'...., ao. . ;41111. 11 •.• 4..(,,,T *(. .
„il 1
,, • y Ink -----.... \\\ ...4.-iik - C'trnt":1 'c' , ••
‘.-'Al.31:1'ic°'' v.' ll'Ilv.Y.i.41.., lip"
4 I ''''V ‘Il } .
Itipl-..... , ... 4 1 .
) ,
t 'ci) I
,-.- to 4°
0
0) w
la
L'i:
•0
0
L.�
i
C
N
g ..ct
m
0 D z in 0 z0 m r tDi� m m -0 i < xim 0 O z c D z A I m
OQ r -i -I �7 (n 0 rw. C = m �IqI r
x Q RI p o T ➢ Z ro > ro Cn -1 Z W Qd p�.o",
-I m m QO Co m p C •- -� O cor -�j OC = m z y r rD.. A z /\ m m
O -v D v Z O z rn m 0 m 51 �0 D co O r m O
x cn c> cn D o o z m Cc7 r O O m o O < J -I Q V J m
x ro r x r rr1 m D 1 cn m r flrl 0 Z m o m X ® r T I c m m D m D O -i Z D m m . ffnn Om i z D
z m Z m rr-m O O niL, z D cn D T cn 0 - z o
sx D m D L �7 O O n D ➢ v rr Co = p D I I N
D o c 0' O M m r C-) O �7 O r 0 N z o K m ro m I I O
Cn m m M 00 -I rrn NFr' T ? 0 --4'71O - --1-1 m p - H I I
O W O Z (n z m > x m O ro z rD- x' ` r 0 �_ ��
co Ly� m < C c C rQ ➢ D O o O D m O H O r7.1FYI ���""" T 0_ I
z _ c�i� O C - = m A °° m 0 T 0 W m D W 7V Rm1 0 /�/�J1
D D m C� O C --1 T z m vzi r ro 70
�'1 m X ''Iw ` "
Z (n O D roC r m ro --1 r m c cn L1 cn .n D in
y C r- < m j m m 0 -1 -I W 1T�n z ® Q r
o m C) 0 > c 0 �7 -1 p x c m 1'1 /A C O ��
m K o -n z z Z i_n _I Z D m W - O m m V Mrn � ° Z
Z y ZO fM n (l fDTI __i 0 0 7. -. z O O O o Z K) 0 1 1 1
Cr) m L) Q
0 O C O O m -D DJ m -n T c n 71 m 0 V 10)
D o ro XI r m m -n z r `l (d
r m O cn Z CC1) O 'mD O Cn O -- 0 m p C)1
C Iasi
ro � cnO T cx > ro rn O CD X
m O D Q D D O z m Z CD p 1.1J
m - 0 Q m cn rr_- M D C7 m m O !n r
cn co m e m w m zz ,..,-,-- 0 5
Y C � ) - D -
c x c ® DCOTO � ^ > < X
2 D 0 73 D 00
m ? Cn
.Zm) -I .Zm7 m
m O D m o m x m 0 cn H 0 X 1��qI D m D Z i m I -I
-° ro r ro m D z cn 00 T v m Y z 1e o N r 0 z A m
+ c� -+ —� rn
r -_i -1 m --1 T.
70 0) c W 0 m m -<-< m m h X z O x D D Cn r
p rNn m D D R. mD O Z - O -i cn 'U m r 0 0 > m \
-10 -1zo mmcDil Drn m 0 M 00 m * ozOT �
D
o cn Z D cn m > XI D o m
m r 4 O --I T O cn r- 2 cn 1 m o m x o
cn O D ro m p 0 c cn O > m ro O ro p -I CI TTm0
coc G) m - -I -z-
- -4 m D rC- z (n -1 2 ? c O N
- z 0 O v Cn = z r 0 -I -i 0 I Cn = = A 10®�
D c o ro 0 0 - O I H O D z n D d� Eas
I
00 Z -i ro cn T --I ro m H -n 2 m O D /ry 7
O D Cr) -I D 53 73 < ._.I V J
m O D o z O f=71 .rQn <O mcn
r �O H OJ X Z O 2 ( M N
85 O o z -Z1 m e i =
m 0 r m >n 70 cn m
m m m o r
� ° � > < T
z z 000 m0
o
m
o 0
= 30 -+ 0 .
rn m m m m
zWF zDD
Z D r--1 m
0 rz cn 23
m DC) m
-I 0 Cn 'O
m > co O71 �
inA � M 6-1 70
om
z o 0
_ IT IT z o 0 A— o
-IC m < y
Dv z _ioJ
•
n � 7' 1 \ A / o / o r
O =m m o z \
03 m om / \ III---I 1I-
-0 -0 507. . / —
m n p o
•�
Z m 0
—t I —
..
-I r co Cl) p -o
m
m mn Ou DD \
( y./ O0 7 O '
0 X -
i0 -< TmT�� a, +� ` > —
CO m ' O w /
IV
O m . 1 Q ----\'CO Q - I > )- 4 i �u O r
Z z C m % ' DO
oW 0 ,CD 70 4 ,` "` . - \ O D n
IC) m - A O Z
71
m v
cn m - p mni
up j` \` > 0
o rz
lio 0
O /r „.- s ro �tC
o �] 0q'� ; c:•'`�
D m / "'�s COW
0 O N NOS
A
`s I .� m X 0
> >
a <
(J D m a 1"
Cr) z m G)
0 � 0
m m
r
N
0
0