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Home My WebLink AboutSWG2023-00039 TANK ONLY - SWG Application / Design / As-Built - 2/10/2023 A O N COUNTY 415 N 6TH STREET,SHELTON,0427-96 , 98584 SHELTON:360-427-9670,EXT 400 19114-: MASON BELFAIR:360-275-4467,EXT 400 Services ELMA:360-482-5269,EXT 400 Public Health & Human FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2023-00039 APPLICANT ARNOLD LISA Phone: Address: 211 E OLDE LYME RD SHELTON, WA 98584 OWNER ARNOLD LISA Phone: Address: 211 E OLDE LYME RD SHELTON, WA 98584 SEPTIC INSTALLER Shane Maples-MAPLES EXCAVATING Phone: 360-463-8474 Address: 911 SE Arcadia Road SHELTON, WA 98584 Site Address: 211 E OLDE LYME RD Primary Parcel Number: 321275300225 Permit Description: Replace septic tank Permit Submitted Date: 02/10/2023 Permit Issued Date: 02/15/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 02/15/2024 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Surfacing Sewage? Existing Failure? Shoreline? Horizontal Setbacks Met? Number of Bedrooms: Drinking Water Source: Additional Details: Permit Conditions: 3 Installer is responsible for obtaining Mason County installation approval prior to backfill of system components. 4 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 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. 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: masoncountywa.gov/health/environmental/onsiteloss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY DATE RECENED: MASON CO a I i U 2-0a 3 Co > co COMMUNI VIEWS AMOUNT RE EMU RECEIVEDco cn v Public Health ;Community Health onrref}J}--tA Health)O 2�23 < 0 3 60-4 2 7-96 70.ext.400 or 360-275.4467.eXL L)) 1 415 N.6th Street-Shelton.WA 98584 —J C W G ,),()a"). - 00 ei, z x .11 ON-SITE LY APPLICATION z APPLICAN i PHONE r t Aco ArfOld /N►cho1e Cla(k 3(1)0-301 -51 (1/0 Z c MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 3 l E. ade Lyme Rd • Shelton , wA c185g4 m SITE ADDRESS-STREET,CITY,ZIP CODE '. all E• Ode lime Rd- Shelton, wA 018584 1 NAME OF DESIGNER PHONE NAME OF INSTALLER PHONE v r Hap►es E Cc vatin9 (Shane Maples) 31o0-41P3- 9 -J q N 1,13 TYPE OF WORK(select one) DRINKING WATER SOURCE O ❑ NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z I—/1 COMP NENT(S)TO BE REPLACED/INSTALLED PUBLIC WATER SYSTEM SEPTIC TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE re (S ❑ OTHER a, O.aIJ c OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST r 103 J 0❑ SURFACING SEWAGE hA EXISTING FAILURE ❑SHORELINE ❑ 100FT+PUBLIC/COMMUNITY WELLS 0 t I 1 SUBMITALS 0 SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS a PLOT PLAN(REQUIRED) ANK CROSS SECTION(REQUIRED) 0 10FT+DRINKING WATER SUPPLY LINES IIS) ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) 0 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS PLOT PLAN CHECKLIST r 0 o PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES ❑ WELLS WITHIN 100FT 0 WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC... ❑ DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR I'n DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) V 1 DecOmmissiOn Failed Sept; c-IAA� and replace With (00 ink i iya ,( phG t-aui &K - ne Lo ca fiorl OFFICIAL USE ONLY BELOW THIS LINE UPGRADE I FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER: COMMENTS/CONDITIONS 910 -(2, rimy\ 3G IV iro v-bc (A AV% M.- 4 Gho\ CCU U4 w6kVw oV 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 i 61V-1 NOri.nk\s„)/, Nyir,N THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12n/2015 4. 15' 2 APPROVED rr FEB 15 2023rr MASON COUNTY ENVIRONM.ENjAU HEALTH RET * ,111 dew (420°41. w . tic `` Wow 0 Q e X Wo`4 E. olde Llnic Rd. ,r► --- : FILTRATOR® Ap IM-1060 INFILTRATOR pROV septic tanks (llyTYgl Features&Benefits RF7, /YTAL H trong injection molded polypropylene -AIIL {ruction f I 1 • Lightweight plastic construction and : . inboard lifting lugs allow for easy - - J// fi7i (t (f 4v. • tegral heavy duty green lids that 1 i I interconnect with TWTM risers and pipe i ( riser solutions ttttttt t�[K'[IN K tt Nt K 11 Illt • Structurally reinforced access ports eliminate distortion during installation and pump-outs • Reinforced structural ribbing and fiberglass bulkheads offer additional . ' strength • Can be installed with 6"to 48" 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 W ' T Riser for guidance. System- ------__. • Partition ry baffle wall ' r HEAVY DUTY LID CUTAWAY Reinforced 24"structural . access port r I ` Structural �r bulkheads MID-SEAM CUTAWAY Reinforced water tight mid-seam gasketed connection Ilk .1 ^.vir i INFILTRATOR® Protecting the Environment with Innovative Wastewater Treatment Solutions water technologies oriommomislimmillmor 1 IM-1060 General Specifications and Illustrations RISER CONNECTION LIFTING STRAP LIFTING LUG / (TYPICAL) ,_I4 TOTAL) (TYPICAL) The IM-1060 is an injection molded two piece mid-seam P- 1 t ��„ `� plastic tank. The IM-1060 injection molded plastic design ;m iggi/ , I t 11'-1 It , A allows for a mid seam joint that has precise dimensions A o L� ► "NO 1 1 1 I r'.I'Q ��„� r•1, o for accepting an engineered EPDM gasket. Infiltrator's '� ;._-_ o o t 6 11__ gasket design utilizes technology from the water industry 'T�` °oo ; °o�.T.r 621 to deliver proven means of maintaining a watertight seal. .';:I! . �� u r r L. ``]' EXTERIOR • ��_ �1'� d :r:4 WIDTH The two-piece design is permanentlyfastened usinga `�' f� + + I ■ *i series of Anon-corrosive plastic alignment dowels and ��I '" t IA lif locking seam clips. The IM-1060 is assembled and sold through a network of certified Infiltrator distributors. ,770(32261 EXTERIOR LENGTH -) TOP VIEW Must be backfilled and installed in accordance with Infiltrator Water Technologies, Infiltrator IM-Series Sep t P [� Tank General Installation Instructions and for shallow 1� R O ground water conditions reference the Infiltrator IM- � � Series Tank Buoyancy Control Guidance. FEB 5 2023 rrll� —I�I— �I11 C MASON COUNTY Eh10RONMEN - _- _ _ 54.7 Please visit www.infiltratorwater.com/images/pdf/ _o-o " 1389] ,I 'T _ `;) EXTERIORManualsGuides/TANK01.pdf for the latest information. RET �iiii I�I ��II HEIGHT TAM QIP/A��C (TVPICAL)IM-1]WO LIFTING STRAP `' *I (TYPICAL) Working Capacity 1094 gal(4141 L) 1287 gal(4872 L) END VIEW Total Capacity Airspace 16.5% Length 127"(3226 mm) 0 4 t1o21 0 24(610]ACCESS OPENINGS MIN LOCKING LIDS(2) g PVC OR ABS t021260]FREEIk)ARD 04(1021PVCCR Width 62.2"(1580 mm) INLET TEE 04(1021 '/CO ET TEE g �i .�� I� I�� Length-to-Width Ratio 2.3 to 1 1e.s C ♦ AIRSPACE OUTLET Height 54.7"(1389 mm) C— 0y ' n]] ERE ' ae.o Li id Level 44"(1118 mm) L Q (11181 FIBERGLASS FIBERGLASS ORT LIQUID SUPPORT Invert Drop 3"(76 mm) IT�, 1 DEPTH (TYPICAL) WITH BAFFLE Fiberglass Supports 2 REQUl WHERE Compartments - 1 or 2 Maximum Burial Depth 48"(1219 mm) SIDE VIEW Minimum Burial Depth 6"(152 mm) 1, Maximum Pipe Diameter 6"(152 mm) TANK TOP CONTINUOUS Weight 320 lbs(145 kg) HALF GASKET TANK — INTERIOR r SEAM CLIP ALIGNMENT DOWEL _.___._ TANK BOTTOM ,,.. - . q HALF � 4 Business Park Road P.O.Box 768 Old Saybrook,CT 06475 N F 1 LT R AT O R 860-577-7000•Fax 860-577-7001 MID-HEIGHT SEAM SECTION 1-800-221-4436 water technologies www.lnflltratorswater.com U.S.Patents 4,759,661;5,017,041;5,156,488;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, Orack4,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,MicroLeaching,PolyTut(,ChamberSpacer,MultiPort,PosiLock,Qulckeut,OuickPlay,SnapLock and StraightLock are trademarks of Infiltrator Water Techno)ogies. PotyLok is a trademark of PotyLok,Inc.TUF-TITE is a registered trademark of TUF-TITE,INC.Ultra-Rib Is a trademark of IPEX Inc. C 2018 Infltrator Water Technologies,LLC.All rights reserved.Printed in USA 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 a0a3-000361 Parcel #3;.1 a1 - 6 - 009as Applicant Name LSO Arnold Subdivision (Name/Div/Block/Lot) Applicant Address aI I E C)Vk Lyme Rd ii e1 Limexic— Div. q Lot??' City, State, Zip shCI-ton, v\IA ggSgei Installer Name Maple Ct Vc hno) Site Address pll £ ode, L14me, Rd Designer Name - INSTALLATION CHECKLIST ❑ Full System Installation Tank(s)Only D Drainfield Only ❑ Repair 0 Other System Type (:1r01V1 tvj Pretreatment Type >5 ft. from foundation? - - ❑ N/A [ YES ❑ NO >50 ft. from wells? - -- 0 lid ❑ Z >50 ft. from surface water? - - ❑ WI ❑• Cleanout between building and tank? - /�, 0 U Tank baffles present? - - 0 L�! 0 H 24" access risers over each compartment?- - 0 0 O. W Effluent filter installed?- •- ❑ AI ❑ N 1tYG11-0( Septic tank capacity(working) I(�1�O gal Manufacturer 1�� 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO DOJ Manifold/D-box accessible from surface?- - ❑ El 00 Z Check valves installed? - - ❑ ❑ ❑ GQ E Transport Line Size Schedule/Class Bedrooms installed (check one) 512 ❑3 0 4 0 5 ❑6 0 Commercial/Other >10 ft.from foundation? - - ❑ N/A ❑ YES ❑ NO O >100 ft.from wells?- - ❑ 0 0 W >100 ft.from surface water? - - ❑ ❑ ❑ ti >10 ft.from potable water lines?- - ❑ ❑ 0 Z > 5 ft.from property lines and easements?- - ❑ 0 0 £ > 30 ft.from downgradient curtain/foundation drains? - - ❑ ❑ ❑ CI Drainfield level and observation ports present - - ❑ 0 ❑ 0 Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ 0 0 Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO • Pump tank capacity(flood) gal Manu cturer < 24" access riser(s) and accessible from surface - 0 0 0 H a Alarm or Control Panel Installed? - - El ❑ 2 Control Panel equipped with Timer/ETM /Counter- - - ❑ ❑ ❑ D Cl- Pump installed in ❑ Bucket or ❑ On Block or Other a' Pump Make/Model ❑ Floats or ❑ Transducer a Tank draw down in/min Pump ca acity gpm Squirt Height ft Pump on time Pum off time Daily flow set at gpd updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel # 3PIPR- - 00a' s ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - (( YES NO If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - YES 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 installaton approval and related permits. di Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ ENGINEER 1 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. 17/Z3 Signature of Installer Date Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: cZI-N.A4,\1(6.4/1 fz z /23 Signature of Environmental 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 Mr■rrnr.. RECORD DRAWING (continued) Farce I# MPS <1 5' a4' r ow( W 101��►n�1�^� B"Ne )o 1oGR�oA C. I Ap p R0v Ed FEB 22 2023 NYIR ONMENi AL NEA��t' MASON OOUNTi E ERI E� OIde Lyme RcL