HomeMy WebLinkAboutSWG2021-00312 - SWG Application / Design - 5/27/2021 (2) MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
J 1. SHELTON:360-427-9670,EXT 400
BELFAIIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2021-00312
APPLICANT SOUZA DAVID Phone:
Address: 3021 NE 72ND DR 9-324 VANCOUVER, WA 98661
OWNER SOUZA DAVID Phone:
Address: 3021 NE 72ND DR 9-324 VANCOUVER, WA 98661
SEPTIC DESIGNER Jim Hunter and Associates Phone: JIM 360-507-1265
Address: PO Box 162 OLYMPIA, WA 98507
SEPTIC INSTALLER BILL MCTURNAL Phone: 360-866-4594
Address: PO BOX 12048 OLYMPIA, WA 98508
Site Address: 220 E SHORECREST DR
Primary Parcel Number: 320215303005
Permit Description: New four bdrm-gravity trench (revision)
Permit Submitted Date: 05/27/2021
Permit Issued Date: 06/07/2021
Issued By: Luke Cencula
Current Permit Fees Paid: $475.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/03/2024 (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 Drain field 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.
7 Gravelless chambers required per design.
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.
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OFFICIAL USE ONLY—•-
-
MASON COUNTY PUBLIC HEALTH DATE RECEIVED.
ONSITE SEWAGE SYSTEM APPLICATION AMOUNT 7a RFC ENED• •A 0 CI)
415 N 6th Street,(Bldg 8) Shelton WA,98584 Z (IA
Shelton:360-427-9670 ext 400 Belfair:360.275.4467 ext 400 Flank). `t r, ; [l i O 2
Z 6
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APPLICANT PHONE > >
DAVID SOUZA 702 787-8687 m m
MAILING ADDRESS•STREET,CITY,SATE.ZIP CODE
3021 NE 72ND DR 9-324 VANCOUVER WA 98661 c
SITE ADDRESS-STREET.CITY,ZIP CODE CO
220 E SHORECREST DR SHELTON WA 98584 m
INAME OF DES!GNER PHONE V AJ
JIM HUNTER 360-753-1226 I�
NAME OF INSTALLER PHONE
DRINKING WATER SOURCE 0 �C}
CHECK ALLAPPLICAE3LEITEMS 4 `,
lif NEW CONSTRUCTION ❑ RV HOLDING TANK ONLY 0 PRIVATE INDIVIDUAL WELL 1 D-1.
❑ REPLACEMENT SYSTEM ❑ INSTALLATION PERMIT ONLY 0 PRIVATE TWO-PARTY WELL 0
z
❑ TABLES REPAR it SINGLE FAMILY ® COMMUNITY/PUBLIC WATER SYSTEM
❑ TANK(S)ONLY ❑ COMMERCIAL (/ SYSTEM NAME: I 1
❑ UPGRADE TO EXISTING El OTHER: BEDROOMS LOT StZE G 1
❑ EXISTING FAILURE "Recant DrswlnUTeQufrt4
for All lnsullaskns" 4 0. 15 L
r lf]
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O
DIRECTIONS TO SITE-BE SPECIFIC ANDADVISE OF ANY NEEDED INFORMATION FOR ACCESS(ex lucked gate) 17
SHORECREST TO"T", LEFT AT "T' TO LOT ON RIGHT JUST BEFORE MIDWAY. t
o b
-4
ID
SITE MUST RE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE RAGGED WITH TEST HOLE NUMBERS
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE 1 FAILURE SOURCE(for reporting purposet)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE El COMPLAINT ❑OTHER: . .
INSPECTOR SOIL LOGS COMMENTS I CONDITIONS
0 0 _ ?....q &L.'s , ec.....k-s
yy ckg" JUr45 ct s \\ 1 i\--t
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM St=SILT C=CLAY E=EXTREMELY R=ROOTS
INSPECTOR SIGNATURE DATE APPLCATION EXPIRATION DATE APPLI.ION APPROVED BY DATE
bf31) ' 5 3 ,� y4 ,, J,.. . 3
S FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WE REVISED 7217T2o15
It t 6:; 2r" ..---
P6 tot*r from.mason County{:),MS
•
DESIGN FORM—PACE ONE Assessor's Parcel Number0 a Z1,24 -- 53-- -5 0c)5
A design will be reviewed when 3 conies 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 1.'"
PARCEL IDENTIFICATION
Permit Number: SWCI ?j)a[_--CX03I a' .. Designer's Name: JIM HUNTER
Applicant's Name: DAViD SOUZA Designer's Phone Number: 360-753-1226
3021 NE 72ND DR 9-324PO BOX 162
Mailing Address: .__. Designer's Address: .. .
VANCOUVER WA 98661 OLYMPIA WA 98507
City State Zip City State Zip
DESIGN PARAMETERS
• 6.4.1 U Cop/ Treatment Device
0 Glrudon l;in ter and Filter ❑ Mound 0 Sand Lined Grainfield ❑Recirculating Filter.Type:
0 Aerobic Unit Make/Model 0 I)idnlccliun Loui Make/Model _. _ Other: .
Drainfield Type
6rf Gravity ❑Pressure li'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4 Schedule/('lass .
Daily Flow:Operating Capacity 3(yl 0 grd Length 50 ft
Daily Flow:Design Flow 4 80 gird Diameter 4 in
Septic Tank Capacity 1250 gal Number 4
Receiving Soil Type(1-6) 1 Separation (Q ft
Receiving Soil Appl.Rate 0.8 gpd/tt- Orifices
Required Primary Area (g 00 ft' Total Number of Orifices N/A
Designed Primary Arca GO ft2 Diameter N/A in
Designed Reserve Area te00 ltF Spacing N/A in
Trench/lied Width 3 ft Manifold
Trench/lied Length ?_OO !t Schedule/Class
Elevation Measurements I.ength t 8 ii
Original Drainlield Arca Slope t0 % Diameter 4 in
New Slope,If Altered A (A % Preferred manifold configuration used? IkYes 0 No
Depth of Hxcavation up slope 24- in Transport Pipe
from Original Grade n.,t,n.mopr - in Schedule/Class
Designed Vertical Separation 36 in Length 40 ft
Ciravcllcss Chambers Required? 54 Yes 0 No ❑Optional Diameter 4 in
Pump Required? 0 Ycs 56 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day N/A
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity NA gal
Orifice N:A ft Chamber Capacity N/A gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head N/A gpm ❑Timer ❑Elapse Meter 0 Event Counter
Calculated Total Pressure Head N/A ft on N/A ,Pump off N/A _
Comments APIRKOVEV•
JUN072021
Printed from Mason County OMS I_"Y(
- DESIGN FORM—PAGE TWO Assessor's Parcel Numhcr_";_ S, 14 -- . 3-- f 3 O Q `--.,
Permit Number: SWG a02 I --ocys..i 7 .
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
O 'Pest hole locations 0 Drainfield orientation and layout Reference depth from original grade:
❑ Soil logs ❑ Trench/bed dimensions and ❑ Septic tank
❑ Property lines critical distances within layout D Drainfield cover
❑ Existing and proposed wells 0 D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 0 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 ❑ Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
O Location and dimension of 0 Observation ports/clean-outs
primary system and reserve area
0 Lateral placement with distance
to edge of bed Other Information
❑ Buildings ❑ Audible/visual alarm referenced Yes No
❑ Direction of slope indicator 0 Scale of drawing shown on scale 0 0 Design staked out
0 Waterlines bar 0 0 Recorded Notices attached
❑ Roads,casements.driveways. ❑ 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
❑ 0 Waste strength
❑ 0 Flow
DESIGN APPROVAL
The undersigned designer must be notified by i i t I installation ❑ Yes RI No
Signature of 'signer 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 rr tlationv•
e6 t jk.e l - 3v -.z3
.ronmental health Specia • t
01 CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
/ The design is stamped'Approved" by Mason County Public Health.
✓ The Onsitc Sewage Permit has not expired,the Permit Expiration Date is: ��1"-- 3 ,
✓ 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.
tt Updated Date: 1217f20 i 5
Printed d rk�.k�y�t Mason s`h ° uu }.a DMS
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