HomeMy WebLinkAboutSWG2023-00035 - SWG Application / Design - 2/9/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
art: BELFAIR:360-275-4467,EXT 400
Public Health Be Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00035
APPLICANT BICKHAM ET AL ANDREW D Phone:
Address: GEORGINE KINGSBURY BELFAIR, WA 98528
OWNER BICKHAM ET AL ANDREW D Phone:
Address: GEORGINE KINGSBURY BELFAIR, WA 98528
SEPTIC DESIGNER Jim Zimny -Advantage Perc & Design Phone: 360-516-7287
Address: 7178 WINDFLOWER PL NW SEABECK, WA 98380
Site Address: 50 NE Bryan Ln
Primary Parcel Number: 223365100008
Permit Description: New SFR -3BR Gravity
Permit Submitted Date: 02/09/2023
Permit Issued Date: 02/15/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $780.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 02/15/2026 (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 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.
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.
OFFICIAL
USE ONLY
2�It-
DATE RECEIVED � - t aJ
MASON COUNTY
61,10 COMMUNITY SERVICES AMOUNT
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Public Health(Community Health/Environmental Health) L N
415 N.6th 70,Ste et-400 a n,INA 5-4467,ext 400 S W G 1613 - ( Cv �,' o 2
415 N.6th Street-Shelton,WA%584
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT PHONE m m
Andrew Bickham 360-712-1805 1---- Z
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MAILING ADDRESS-STREET,CITY.STATE,ZIP CODE
50 NE Bryan Ln , Belfair wa 98528 m
SITE ADDRESS-STREET,CITY,ZIP CODE
50 NE Bryan Ln, Belfair wa 98528 ^ /�'
NAME OF DESIGNER PHONE r
Jim Zimny 360 516-7287 r...)
NAME OF INSTALLER PHONE N.
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PERMIT TYPE(select one) DRINKING WATER SOURCE N UN
W.
fl IN
Itt7 RESIDENTIAL OSS COMMUNITY OSS COMMERCIAL OSS U PRIVATE INDIVIDUAL WELL d PRIVATE TWO-PARTY WELL Z ^
TYPE OF WORK(select one) a PUBLIC WATER SYSTEM LynnCh Cove Water b
6 NEW CONSTRUCTION/UPGRADES 'Or REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR V
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE w 1
DESIGN FORM(REQUIRED) PI SEPTIC DESIGN(REQUIRED) BEDROOMS 3 LOT SIZE 24ACreS O t
Ig WAIVER(S)(IF APPLICABLE)
X. C
DIRECTIONS TO SITE AND SITE CONDITIONS(ex locked gate)
0
From Belfair tank Stae Route 300( North Shore Rd ) go 3.4 miles and take left on NE Lorna 0
Lee Way, Take Rt on Bryan In. Lot is 450 ft on Rt . Soil logs are visible from rd on east side
of the house. 0 0
0
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS DO
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reportng purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER:
INSPECTOR SOIL L COMMENTS)CONDITIONS
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RECORD DRAIMNG 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.
I CTOR SIGNATURE DATE APPLICATION EXPIRATION DATE LI ATION APPROVED/ISSI JED BY DATE
, ,,„_ ,_,,„.3
THI F Y BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 1?/7I2om
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DESIGN FORM—PAGE ONE Assessor's Parcel Number. L 2.3 3 4, -- c I - d O c o S
4
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 2023 --4oc9' 5 Designer's Name: Jm Zimny
Applicant's Name: Andrew Bickham 360 516-7287
Designer's Phone Number:
Mailing Address: 50 NE Bryan Ln Designer's Address: 7178 Windflower PI NW
Belfair WA 98528 Seebeck WA 98380
CLEAR FORM
City State ____Zip___ City State Zip
DESIGN PARAMETERS
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
i 0 Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
lo'Gravity 0 Pressure 0 Trench mrBed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 2729
Daily Flow: Operating Capacity 270 gpd Length 45 ft
Daily Flow: Design Flow 360 gpd Diameter
4 in
Septic Tank Capacity(working) /5 3 gal Number 3
Receiving Soil Type(1-6) 3 Separation 3 ft
Receiving Soil Appl.Rate 0.8 gpd/ft2 Orifices
Required Primary Area 450 ft2 Total Number of Orifices N/A
Designed Primary Area 450 ft2 Diameter in
Designed Reserve Area n/A ft2 Spacing in
Trench/Bed Width 10 ft 4,1r , Manifold
TrenchBed Length 45 ft Sched ,.= t� N/A
�t
Elevation Measurements Len'.le
x'= ' �t r ft
Original Drainfield Area Slope 2 % 1; '�T "(cor to
New Slope,If Altered % r;:;,,= �%� +1; � 1 figuration used? ❑Yes ❑No
Depth of Excavation Up slope 20 in Expires:6717/ Transport Pipe
from Original Grade Down-slope 12 in Schedule/Class 3034
Designed Vertical Separation 36 in Length 25' ft
Graveness Chambers Required? ❑Yes le No ❑Optional Diameter 4�� in
Pump Required? 0 Yes Er No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day N/A
Diff. in Elevation Between Pump&Uppermost Orifice ft Dose quantity gal
Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity (flood) gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity Total Pressure Head gp .?Elapse Meter ❑ Event Counter
ppTy Calculated Total Pressure Head 0 It o �� ,Pump off
Comments FEB 1 5 2023 ,''
MASON COUNTY ENVIRONMENTAL HEALTH
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DESIGN FORM—PAGE TWO Assessor's Parcel Number. Z Z 33 i r' — S 1 — O c Q V 8
• Permit Number SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
1E1 Test hole locations V Drainfield orientation and layout Reference depth from original grade:
V Soil logs V Trench/bed dimensions and IV Septic tank
Er Property lines critical distances within layout B Drainfield cover
El Existing and proposed wells Er D-Box/Valve box locations Reference depth from original grade
within 100 ft of property Lot Septic tank/pump chamber and restrictive strata:
O Measurements to cuts,banks,and locations 1 Laterals,trench/bed,top and
surface water and critical areas la Observation port location bottom
V Location and orientation of 0 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption 0 Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
P1 Location and dimension of g Lateral placement with distance V Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
El Buildings 0 Audible/visual alarm referenced Yes No
O Direction of slope indicator Ef Scale of drawing shown on scale 0 V Design staked out
❑ Waterlines • bar Cl ❑ Recorded Notices attached
El Roads,easements, ;v ❑ ❑ Waivers)attached
parking4•4 R 0 v E r G ❑ ❑ Pump curve attached
❑ 0 Evaluation of failure
✓ North arrow and `. _ dravyppg, 1 5 2023 '��
shown on scale b ,f'' Non-residential justification
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MASON COUNTY ENV RONMENTAL HE;;�' ' `s. 0 0 Waste strength
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Lam., . I'.(G. ❑ ❑ Flow
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The undersigned designer must be notified b s ler at ti of installation Er Yes ❑ No
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Signature o De ' er 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 o Si ulations:
/
A ,, 2—(5--2-3
En ro tal Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. ( �
V The Onsite Sewage Permit has not expired,the Permit Expiration Date is: Z
✓ 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.
Updated Date: 12/7/2015
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Advantage Perc & Design
Temely-Reasonab+e-30 Years of Local Experience
Construction Notes for Gravity Distribution bed for 3 Bedroom System:
Gravity Bed Distribution w/Rock and pipe
Install 10 x 45' beds.
Install 6 outlet d-box with an outlet pipe going to each infiltrator leg using speed levelers.
D box must have an access riser to the surface of the ground.
Install 20" deep and level in trench
Install in dry weather only.
Use 1500 Gallon septic M-1530 infiltrator tank W/water-tight secured risers to the surface of the
ground.
System designed for typical residential waste strength sewage only.
System designed for 360 Gallons Per Day
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IM-1530 General Specifications
and Illustrations
LIFTING LUG(TYP.) RISER CONNECTION(TYP.)
The IM-1530 is an injection molded two piece mid- ;LIFTING STRAP(TYP.) , /
seam plastic tank.The IM-1530 injection molded —
plastic design allows fora mid-seam joint tha has `, 11it1 I I I I 4':4I I NIII1,4 to;,
precise dimensions for accepting an engineered ii till" W liar kll UP �`\ '°i
EPDM gasket. Infiltrator's gasket design utilizes '�i 1 �( ° .. r. . ..=,..1,..,... 1:.15:71technolo from the water indu to deliver EXTERIOR
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proven means of maintaining a watertight seal. ; , _ ,f'l" {l"�•4.4._ -lr.l all►
The two-piece design is permanently fastened
v� •a •• :a i 1:.. � i • w.i►.
using a series of non-corrosive plastic alignment
dowels and locking seam clips.The IM-1530 is 175.E 14.460I EXTERIOR LENGTH
assembled and sold through a network of certified
Infiltrator distributors. TOP VIEW
Must be backfilled and installed in acco .-. P
® Vwith Infiltrator Water Technologies, Infiltr• -. ' az
IM-Series Septic Tank General Installation FEB 5 ' 3 `
Instructions and for shallow ground water Ail` ,, ' 1
conditions reference the Infiltrator IM- : - 8#COUNTY ENVIRONMENTAL HEALT i5Ls
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Tank Buoyancy Co►rtrol Guidance. JBW ,_ _______ _ EXTERIOR
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Please visit www.infiltratorwater-images/ SEA''' ) ' Er
pdf/ManualsGuideslTANK01.pdf for the latest � ` f
information. ("'P)
IM-1530 END VIEW
Working Capacity 1537 gal(5818 L) Q::`'�
Total Capacity 1787 gal(6765 L) 024.0(e101 ACCESS PORT
04(:r WITH LOCKING LIO(3)
Airspace 16.9% �P" ;�! WITH� ,n, FRF Rn 04t'021
Length 176"(4460 rmi) 11 _iiiirims OUTLET TEE
Width 62'(1567 rnm) 30 l 111111 _
f78jCPOOOE 0.2[5]WLLLER
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Length-to-Width Ratio 2.8 to 1 441fL THICKNESS
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Height 55"(1384 mrrd) CODE 2[s11x2(s,) l
FIBERGLASS
SUPPORT(4)
Liquid Level 44"(1118 rrirl) - P)
Invert Drop 3"(76 mm)
Fiberglass Supports 4 SIDE VIEW
Compartments 1 or 2
Maximum Burial Depth 48'(1219 mm) CONT1NtOus
it i TANK ••HALF - ELASTOMERIC
Minimum Burial Depth 6"(152 mm) .> ++' GASKET
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Maximum Pipe Diameter 4°(100 mm) .r�+ TANK
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:3 'I`, • 0 INTERIOR SEAM CLIP
Weight 501 lbs(228 kg) :�, ",++,
%�`�' ' :,,33 Vie
- Nr .'1 GNMENT
L i.ED DESIGNER •! TANK BOTTOM HALF
Expires:t)/177e7 1,4 Buss Park Road C
P.O.Box 788
Old Saybrook,CT 08475
577 7001 MID-HEIGHT SEAM SECTION
f N F f LT R AT O R'
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Pol'Lok is a trademark of PolyLok,Inc.TUF-TTTE is a registered trademark of TUF-TTTE,INC.Ultra-Rib is a trademark of IPEX Inc.
02014 Infiltrator Water Technoiogles,LLC.AB rights reseneerL P,:i ed in U.S.A. IM21 1116
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