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Home My WebLink AboutSWG2023-00019 TANK ONLY - SWG Application / Design / As-Built - 1/27/2023 A O N COUNTY 415 N 6TH STREET,SHELTON,967 , 98584 M AS SHELTON: 360-427-9670,EXT 400 BELFAIR: 360 275-4467,EXT 400 !Alialp Public Health & Human Services ELMA: 360482-5269,EXT 400 FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2023-00019 APPLICANT HUEY SELBY G Phone: Address: 1317 DICKINSON AVE SHELTON, WA 98584 SEPTIC INSTALLER Shane Maples-MAPLES EXCAVATING Phone: 360-463-8474 Address: 911 SE Arcadia Road SHELTON, WA 98584 OWNER DYSON STANLEY E Phone: Address: 1307 DICKINSON AVE SHELTON, WA 98584 Site Address: 1307 Dickinson Ave Primary Parcel Number: 320291200080 Permit Description: Replace septic tank Permit Submitted Date: 01/27/2023 Permit Issued Date: 02/08/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 02/08/2024 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Septic Tank Only Surfacing Sewage? No Existing Failure? Yes Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 2 Drinking Water Source: Public Water System Additional Details: IM-1060 Permit Conditions: 3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 4 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. 1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval 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 CONDITIONSAPPROVED. CHANGED SINCE THE SITE WAS INSPECTED AND/OR DESIGN 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. t OFFICIAL USE ONLY DATE RECEIVED. .1 1 ✓ 12 MASON COUNTY I " J cn f l COMMUNITY SERVICES AMOIj�IT RECEIVE CO U) l Public Health(Community Health/Environmental Health) //�� N 0 415 N.6rh Sr t h It n.WA 985847.ext.4W 5 //-� �2 - CI b /-� I c � 47 S N.6th Street-Shelton,WA 98584 V\11//v' 71`/l O Z fn ON-SITE SEWAGE TANK ONLY APPLICATION 3 m m APPLICANT PHONE r Sel �kU�� / �t�tn D v s�►�-, 31o8 '�BI � dgf Z MAILING ADDRESS-STREET,CITY.STATE.ZIP CODE W i3o7 5E DiC4nson Ave. SheItoti, WA 0)g58Li m SITE ADDRESS-STREET,CITY,ZIP CODE I'`, AO7 SE DICI6i nSQ1/1 AvC- Shel v�, way �ig584 NAME OF DESIGNER PHONE IC3 NAME OF INSTALLER PHONE 0 I) MOPIC( Vxcgvq-inl (Sham, Maple ) 3l.00 LfLo? , S41L `- IN N TYPE OF WORK(select one) DRINKING WATER SOURCE 0 IDNEW CONSTRUCTION/UPGRADES El REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z I.,,4 COMPONENT(S)TO BE REPLACED/INSTALLED PUBLIC WATER SYSTEM I SEPTIC TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE I-- ❑ OTHER 7 0 1 2 a of-Z coIN OTHER DETAILS(select all that apply) TAN (S)SETBACK CHECKLIST 0 �/ n I ❑ SURFACING SEWAGE p EXISTING FAILURE 0 SHORELINE 100FT+PUBLIC/COMMUNITY WELLS I® SUBMITTALS 14 SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS PLOT PLAN(REQUIRED) EITANK CROSS SECTION(REQUIRED) ta 1OFT+DRINKING WATER SUPPLY LINES ❑ PUMP DETAILS(IF APPLICABLE) ❑ WAIVER(S)(IF APPLICABLE) 2(5FT+PROPERTY!EASEMENT LINES,FOUNDATIONS,FOOTINGS r pPLOT PLAN CHECKLIST ❑ 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... 41 ❑ DIRECTION OF SLOPE/CONTOURS 0 PERIMETER/CURTAIN DRAINS 0 NORTH ARROW 0 SCALE BAR y� DIRECTIONS TO SITE AND SITE CONDITIONS.(ex.locked gate) Decornsiori oid/foist-cd-ta lK an o ReplQce wi f nfi Itr t�or sep� c -t-any, Sara t L0�1 n \ D LyJAN272023 - --- OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(tor reporting purposes) ❑VOLUNTARY ' tAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT 0 OTHER: COMMENTS/CONDITIONS ‘c4—AGICAS- fz C 4r\,\C___ 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 ION /7/1 Wm 4S/2-3THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE ��' REVISED 12l7/2015 0 i V C 0 HOUSe ai t lobo— tn � r..p•te �' I OCo.tcon 9 APPROVED FEB 0 8 2023 MASON COUNTY ENVIRONMENTAL HEALTH RET usl Par cet 3202 t-ii-Oe0Et0 � C3 � rNFILTRATOR tanks1 M—1060 Features&Benefits • Strong injection molded polypropylene construction t • Lightweight plastic construction and inboard lifting lugs allow for easy / 11 / delivery and handling { f `/, • Integral heavy-duty green lids that / ' . / interconnect with TWTM risers and pipe riser solutions • Structurally reinforced access ports KKtrtt�f�� 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 CUTAW I _ - / native soil. See installation instructions P P R O��i _ •r.� for guidance. Sys em FEB 0 8 2023 MASON COUNTY ENVIRONME, • Partition baffle wal\ RE _ HEAVY DU LID CUTAWAY f 401H. Reinforced 24" structuralTY ;f access port f Structural • .i s bulkheads . i MID-SEAM CUTAWAY Reinforced water tight mid-seam gasketed connection 4 i 17.' ir INFILTRATOR' Protecting the Environment with Innovative Wastewater Treatment Solutions water technologies i IM-1060 General Specifications and Illustrations RISER CONNECTION LIFTING STRAP LIFTING LUG (TYPICAL) (4 TOTAL) / (TYPICAL) The IM-1060 is an injection molded two piece mid-seam �� „� `1 plastic tank. The IM-1060 injection molded plastic design ;L ��1 1I I T g~ �1, �..r. P�i� 1 sir- t•' A allows for a mid seam joint that has precise dimensions A �ii s1 11 1 , u re 4;!,A A 4 Iasigt a �`.;'..1 for accepting an engineered EPDM gasket. Infiltrator's , o o - • B III o )!. = c bgasket design utilizes technology from the water industry �_._ o ' ' o T�fa nseo, ;11� /-- tl� EXTERIOR O 1 1. 1 t 1\ / ` I'�to deliver proven means of maintaining a watertight seal �ii� _ �, �`�., mom The two iece desi n is ermanentl fastened usin a irri rek i + *`�U series of non corrogive pastic alignment dowels and ' I rM Iva . locking seam clips. The IIM-1060 is assembled and sold through a network of certified Infiltrator distributors. _--___ 1270(3226;EXTERIOR LENGTH TOP VIEW Must be backfilled and installed in accordance with Infiltrator Water Technologies, Infiltrator IM-Series Septic OUTLET Tank General Installation Instructions and for shallowAllitip ground water conditions reference the Infiltrator IM-Series Tank Buoyancy Control Guidance. I{ _ 1c "II -i54.7 Please visit www.infiltratorwater.com/images/pdf/ _ _-o_0 11389) i E� !I -! �, EXTERIOR ManualsGuides/TANK01.pdf for the latest information. SEAM CLIP V�I MI IIHEIGHT (TYPICAL) 1\� 1CC ♦/ `IM-1OYO LIFTING STRAP `1S►_,•-•. WorkingCapacity 1094 gal(4141 L) (TYPICAL) p y Total Capacity 1287 gal(4872 L) END VIEW Airspace 16.5% Length 127"(3226 mm) PVC 00R4(11 ABS21 0 24(6101 ACCESS OPENINGS WITH LOCKING LIDS(2) —10.21:60)FREEBOARD 04I1021PVCOR Width 62.2"(1580 mm) INLET TEE / ABSOUTLETTEE Length-to-Width Ratio 2.3 to 1 j INLET ( 1SPAC '�-r+r r{JTfW1-\, AIR SPACE OUTLET Height _ 54.7"(1389 mm) `DPER I& L 00 OE Liquid Level 44"(1118 mm) µ•0 E L A [11181 FIBERGLASS FIBERGLASS LIQUID SUPPORT Invert Drop 3"(76 mm) SUPPORT DEPTH r(TYPICAL) WITHALBAFFLE -T Fiberglass Supports 2 WALL WHERE REQUIRED Compartments 1 or 2 ,----1 'R Maximum Burial Depth 48"(1219 mm) SIDE VIEW Minimum Burial Depth 6"(152 mm) Maximum Pipe Diameter 6"(152 mm) TANK TOP 1 CONTINUOUS Weight 320 lbs(145 kg) HALF GASKET APPROVED INTERIOR // SEAM CLIP FEB 0 8 2023 ALIGNMENT DOWEL N TANK BOTTOM w' MASON COUNTY ENVIRONMENTAL HEALTH HALF ',� 4 Business Park Road ET P.O.Boxy 7600 R Old Saybrook,CT 0647 N F I LT R AT O Rf 860-577-7000•Fax 860-577-7001 MID-HEIGHT SEAM SECTION 1-800-221-4436 water technologies www•intiltratorswater.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, Ouick4,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,MioroLaxhing,PolyTuff,CharnbarSpaoar,MUItiPort,PoahLock,OuiokCut,OuickPlay,SnapLock and StmlghtLock are trademarks o1 Infiltrator Water Technologies. PolyLok is a trademark of Pofylok,Inc.TUF-TITE is a registered trademark of TUF-TITE,INC.Ultra-Rib is a trademark of IPEX Inc. 0 2016 Infiltrator Water Technologies,LLC.All rights reserved.Printed in U.S.A. IM02 1116 Contact Infiltrator Water Technologies' Technical Services Department for assistance at 1-800-221-4436 a .. Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG 2.N3-MO Parcel # 3 202e1- 12 - 000 0 Applicant Name Seib" tluoi / cianlei DlsGln Subdivision (Name/Div/Block/Lot) Applicant Address 1311 D 1Ca:41COn AVP, City, State, Zip Steel-ii' 1 NA °85gLi Installer Name mapleS ExCOVA-hr) Site Address tell DtCXanson Ave. Designer Name INSTALLATION CHECKLIST ❑ Full System Installation Tank(s)Only ❑ Drainfield Only ❑ Repair ❑Other System Type C-lrovitvi Pretreatment Type >5 ft.from foundation? - - ❑ N/A [��/YES ❑ NO >50 ft.from wells? - '- ❑ ►Yf ❑ Z >50 ft. from surface water? - - ❑ I ❑ < Cleanout between building and tank? - - ❑ DE ❑ ✓ Tank baffles present? - - ❑ ,�,/ ❑ a24" access risers over each compartment?- - ❑ E3 ❑❑ W Effluent filter installed?- ❑ N n-Fl t Y41 it Septic tank capacity (working)al/0 gal Manufacturer 0 D-box water level and speed levelers used? - - ❑ N/A ❑ YES ❑ NO �J ❑ ❑ ❑ O Manifold/D-box accessible from surface?- - u. mZ Check valves installed? - - ❑ ❑ ❑ Oa 2 Transport Line Size Schedule/Class Bedrooms installed (check one) 4 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10 ft.from foundation?- - ❑ NIA ❑ YES 0 NO O >100 ft.from wells?- - ❑ ❑ El W >100 ft. from surface water? - - ❑ ❑ ❑ LT_ >10 ft.from potable water lines?- - ❑ ❑ ❑ Z > 5 ft.from property lines and easements?- - ❑ ❑ ❑ Q El El ❑ re > 30 ft.from downgradient curtain/foundation drains? - - 0 Drainfield level and observation ports present 0 ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO • Pump tank capacity (flood) gal anufacturer 4 24" access riser(s) and accessible from s ace?- - ❑ ❑ El ~ Alarm or Control Panel Installed? - ❑ ❑ Li a 2 Control Panel equipped with Timer/ETM /Co ter- - ❑ ❑ ❑ M a Pump installed in ❑ Bucket or ❑ On B c or ❑ Other a'• Pump Make/Model ❑ Floats or ❑ Transducer 0. a Tank draw down in/min mp capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpd Updated 8'21/2018 orrow Mason County OSS Installation Report pg. 2 Parcel # ;x961' la-&NM ABANDONMENT RECORD Were existing septic components abandoned as part of this project? - - d 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 installation approval and related permits. 121 Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER I 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. Signature of Installer Date SiAnt V1 aie tM Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: Signature of Environment I 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 dimmibk RECORD DRAWING (continued) SE Di(4 r coon Ave }I(L6ei ro' c —Neu i01o0 it'1 rAtOr itiat- I30 1 110u , Cno ,pl hir-A3> g 0` APPROVED FEB 22 2023 MASON COUNTY ENVIRONMENTAL HEALTH RET parcel# 32e i-12 -000g0