HomeMy WebLinkAboutSWG2022-00587 - SWG Application / Design - 11/23/2022 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
n,. . SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2022-00587
APPLICANT MCMASTERS DEREK J Phone:
Address: 130 E HILLDALE RD UNION, WA 98592
OWNER MCMASTERS DEREK J Phone:
Address: 130 E HILLDALE RD UNION, WA 98592
SEPTIC DESIGNER DALE TAHJA-Septic Designer Phone: 360-426-5940
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
SEPTIC INSTALLER TJ Goos-TJ's Excavating Phone: 360-490-0217
Address: 150 E MARISA PL SHELTON, WA 98584
Site Address: 61 N BASS PL
Primary Parcel Number: 422165300035
Permit Description: New SFR -2BR Oscar drip
Permit Submitted Date: 11/23/2022
Permit Issued Date: 02/03/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $900.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 01/06/2026 (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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
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OFFICIAL USE ONLY
�J DATE RECEIVED:
MASON COUNTY I2.3 I 9--fl COMMUNITY SERVICES �� ca
AMOUNT RECEIVED: RECEIVED BY:
- � �G o Cl)
Public Health(Community Health/Environmental Health) C Cl)
415 N.U7,Street-ShNton,WA98580 SWG S G3-7 6 N
Z ch
ON-SITE SEWAGE SYSTEM APPLICATION 3
APPLICANT PHONE m
r
Derek McMasters (253) 205-1877 ,— c
ca MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE T. 3
130 E. Hilldale Rd. Union WA 98592 CD n D3
SITE ADDRESS-STREET,CITY,ZIP CODE C
61 N. Bass Pl. Hoodsport WA 98548 r f .4,.
NAME OF DESIGNER PHONE N I IV
Dale L. Tahja (360) 426-5940 m
NAME OF INSTALLER PHONE v I N
T.J. Goos (360) 490-0217 R
PERMIT TYPE(select one) � DRINKING WATER SOURCE O
RESIDENTIAL OSS COMMUNITY OSS d-_4COMMERCIAL OSS PRIVATE INDIVIDUAL WELL 6 PRIVATE TWO-PARTY WELL
NP-PUBLIC WATER SYSTEM Lake Cushman Z I
TYPE OF WORK(select one)
I
fiji.NEW CONSTRUCTION/UPGRADES E REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR CD I ()I
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINECD
Pr DESIGN FORM(REQUIRED) 5ffSEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE 0 I W
b WAIVER(S)(IF APPLICABLE) 2 0.21 acre o I O
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
Goup to Lake Cushman, turn left toward the lower lake, turn left onto Rainbow Way, turn I o
right onto Bass Place, property on the left. o I o
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C1I
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. CT1
----- — OFFICIAL USE ONLY BELOW THIS LINE--
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER: 1
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS Is
.°.\\ SA-\(\ /2-5 -. 1A\\ oc ti\laA-uvt 6-46-0 a .4-4.,..,-c, . g
Sr. v'1 t)� 'b�n� soli ,,��. _�
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RECORD DRAWING AND INSTALLATION RlikORT a
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 APP TIO APPROVED/ISSUED BY
THISBY DATA
FORM BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/72015
, -a
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 4 2 2 1 6 — 5 3 — 0 0 0 3 5
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. '1 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 2022-00587 Designer's Name: Dale Tahja
Applicant's Name: Derek McMasters Designer's Phone Number: (360)426 5940
Mailing Address: 130 E. Hilldale Rd. Designer's Address: 2450 W Deegan Rd W
Union WA 98592 Shelton WA 98584
City State Zip City State Zip
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: Oscar II OS-50
Drainfield Type
❑ Gravity lit Pressure 0 Trench l 'Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class OS-50 Coils
Daily Flow:Operating Capacity 180 gpd Length 5X5 ft
Daily Flow:Design Flow 240 gpd Diameter drip in
Septic Tank Capacity(working) 1,200 gal Number 5
Receiving Soil Type(1-6) 4 Separation 0.5 ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 400 ft2 Total Number of Orifices 250
Designed Primary Area 400 ft2 Diameter drip in
Designed Reserve Area 400 ft2 Spacing 50 emitters/coil in
Trench/Bed Width 14 ft Manifold
Trench/Bed Length 29 ft Schedule/Class Sch. 40
Elevation Measurements Length 10 ft
Original Drainfield Area Slope 0 % Diameter 1 in
New Slope,If Altered 0 % Preferred manifold configuration used? 0 Yes G7SNo
Depth of Excavation Up-slope 4 in Transport Pipe
from Original Grade Down-slope 2 in Schedule/Class Sch. 40
Designed Vertical Separation 24 in Length 150 ft
Gravelless Chambers Required? 0 Yes Wi No 0 Optional Diameter 1 in
Pump Required? Et Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day per Oscar II requirements
Duff.in Elevation Between Pump& Uppermost Orifice 10 ft Dose quantity per Oscar II requirements gal
Drainfield Squirt Height/Selected Residual(head) drip ft Chamber Capacity(flood) 1,000 gal
Uppermost Orifice li 'Higher 0 Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head 11.5 gpm ❑'Timer ❑Elapse Meter ❑Event Counter
Calculated Total Pressure Head 1$ st �, Iff,,:r er.-Pulmp on per 0 t�_ e I p s r II
14 Comments
fa 0 3 2023 JAN 0 202.3
nlvIRONMENgAL HEAL1
Mas JtaW By
DESIGN FORM—PAGE TWO Assessor's Parcel Number:4 2 2 1 6 — 5 3 -- 0 0 0 3 5
Permit Number: SWG 2022-00587
DESIGN CHECKLISTS .
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Iii Test hole locations 12l Drainfield orientation and layout Reference depth from original grade:
fill Soil logs Et Trench/bed dimensions and liff Septic tank
Fill Property lines critical distances within layout 521 Drainfield cover
Et Existingand proposed wells Et D-Box/Valve box locations
P P Reference depth from original grade
within 100 ft of property g Septic tank/pump chamber and restrictive strata:
EZI Measurements to cuts, banks, and locations Gil Laterals,trench bed,top and
surface water and critical areas l21 Observation port location bottom
l7I Location and orientation of Eii Clean-out location 0 Curtain drain collector
curtain drain and all absorption Et Manifold placement EZ Sand augmentation
components Ii Orifice placement Other cross-section detail:
611 Location and dimension of lid Lateral placement with distance Eif Observation ports/clean-outs
primary system and reserve area to edge of bed
0 Buildings Other Information
lid Audible/visual alarm referenced Yes No
lt Direction of slope indicator sti Scale of drawing shown on scale d Design❑ staked out
j Waterlines bar 0 0 Recorded Notices attached
it Roads, easements,driveways, >,- .0 0 Waiver(s)attached
parking PPROVE 6d' 0 Pump curve attached
It North arrow and scale drawing i
❑ Evaluation of failure
FEB 0
shown on scale bar 2023 n-residential justification
MASON COUNTY ENVIRONMENTAL FIFA'3 ❑ Waste strength
JIM 0 Flow
DESIGN APPROVAL
The undersigned designer mu notified 0. ins ler at time of installation lif Yes 0 No
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Signature of Designer U Date
'\'C‘ -' ,4
The undersigned has reviewed this design on behalf of Mason County Public Health and determin-tr'' . ,ct
compliance with state and local on- ' e regulations:44 � }4►7e\ Q.2
Envi al ealth Specialist D Aa �� �. r� Q
1 V� i/; ,..--1.,
CAUTION: DESIGN APPRO AL IS VALID ONLY UNDER THE FOL 4,1 WING C i .t.tr ' O14: o•t:." ;f
/ The design is stamped"Approved"by Mason County Public Health. Of
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✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: • ,,-" S'� , _ ��%ln.• 0
✓ Drainfield site conditions have not been altered to adversely affect conditioi�• �of design approval. 'il'S-.,, a.•
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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