HomeMy WebLinkAboutBLD2023-00194 - BLD CD Environmental Health Review - 4/7/2022 ez,.19 ,2edc3-- 0/ 9y
ENVIRONMENTAL
MASON COUNTYH EA LT H N 6TH STREET,SHELTON,WA 98584
r {�r t SHELTON:360-427-9670,EXT 400
COMMUNITY SERVICES 1:..�l..-� �' BELFAIR:360-275-4467 EXT 400
ELMA:360-482-5269,EXT 400
Bu . Dianne,y,CarvernmwlWtN«NhCommreutyltaatM' FAX:360-427-7787
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On-Site Sewage System Permit: SWG2022-00189, Adder Street
APPLICANT KNOWLES EDWIN C & CHERYL L Phone: 360-801-8716
Address: 170 NE MAHONIA DR BELFAIR,WA 98528
OWNER KNOWLES EDWIN C & CHERYL L Phone: 360-801-8716
Address: 170 NE MAHONIA DR BELFAIR,WA 98528
SEPTIC DESIGNER Richard Bazzell -Caliber Septic Design Phone: 360-509-7900
Address: 165 Tupleo Way POULSBO,WA 98370
Site Address: 300 E Appaloosa Dr
Primary Parcel Number: 220017600080
Permit Description: New SFR-2BR Gravity W/class b waiver
Permit Submitted Date: 04/07/2022
Permit Issued Date: 05/11/2022
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $500.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 04/07/2025 (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 Drainfield installation not to exceed designed ups/ope 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
backlit!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: www.co.mason.wa.us/health/environmental/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
'rinted From Mason County DM
Printed from Mason County OMS
1
OFFICIAL USE ONLY-
MASON COUNTY DAfMRECEA/E0 _ _ D
COMMUNITY SERVICES �,OZZ N_ v
AMOUNT RECENEU BY
W�0O•a o m
Public Health(CommLnity Health/Environmental l ieel;h') VA
]60a1!'M70.aLe70or]60:75Mb/e.l MO C G 1�� \c /'� O
415 S 61.L:rr.•5nn:on,WA Y818./ S W \�(\fv\1`_.�1{l\ _�
V v O
Z 6
ON-SITE SEWAGE SYSTEM APPLICATION 3
AYUI!CANT PHONE rn m
Edwin & Cheryl Knowles 360-801-8716
MAAII.ING ADDRESS-STREET.CITY.STATE,ZIP COOL 3
300 E Appaloosa Drive Shelton WA 98584 co
m
SITE ADDRESS-STREET,CITY,ZIP CODE .-
300 E Appaloosa Drive Shelton WA 98584 I N
- --- - _. ---------------
NAME OF DESIGNER PHONE
Richard Bazzell 360-509-7900 I C`'
NAME OF INSTALLER PHONE
To Be Determined n/a z
0ERMIT TYPE iseNct One) ORiNICNG WATER SOURCE y
Of RESIDENTIAL OSS COMMUNITY OSS h COMMERCIAL OSS g PRIVATE INDIVIDUAL WELL Ii PRIVATE TWO-PARTY WELL Z
TYPE OF WORT((select one) Q PUBLIC WATER SYSTEM
P(NEW CONSTRUCTION I UPGRADES r i REPAIR I REPLACEMENT OTHER DC TAILS(select a,!!hat apply) 0 TABLE IX REPAIR
SUBMITLus 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE co
mo_ DESIGN FORM(REQUIRED) !I SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE O I 't'
W'WAIVER(S)(IF APPLICABLE) 2 5 acres 0 I
lc,
DIRECTIONS TO SITE AND SI I E CONDITIONS.(ex.cocked gate)
From WA-3 turn onto E Pickering Rd, continue straight on E Harstine I
Bridge Rd, turn left onto E Harstine Island Rd N, urn left onto E o I
Appaloosa Dr, continue on gravel road (2/10 mil ), the private I oQ
driveway is to the riaht (south) and marked/fla ed. °�
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I 0
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(to-reporang cJruoses)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER.
INSPECTOR SOIL LOGS COMMENTS I CONDITIONS
' \\
1
RECORD DRAWING 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.
INSP OR IGNATURE DATE APPLICATION EXPIRATION DATE A LICA ION APPROVED/ISSUED BY DAI E
ir
, tz41 .).f,“Iii ( ' 4/25 ‘2.7 --
Ada
Oktvi\i-, P
II THi= F. , Y BE SCANNED AND AVAILpgt,E-fO E Q T E OUNTY WEBSITE REVISED 121/2015
Printed from Mason County DMS
DESIGN FORM—PAGE:ONE Assessor's Parcel Number: 2 2 0 0 1 — 7 6 — 0 0 0 8 0
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.Afar/mum paper size: 1I"X 17-
PARCEL IDENTIFICATION
Permit Number: SWG OD/V41 Designer's Name: Richard Bazzell
Applicant's Name; Edwin&Cheryl Knowles 3t30-509-7900
PP Designer's Phone Number:
Mailing Address: 300 E Appaloosa Drive 165 NW Tupelo Way
Designer's Address: P
^
Shelton WA 98584 Poulsbo WA 98370
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device
❑Glendon Riofilter 0 Sand Filter 0 Mound 0 Sand Lined Druinficld 0 Recirculating Filter,Type:n/a
❑Aerobic Unit Make/Model n/a 0 Disinfection Unit Make/Model n/a Other: Na
Drainfield Type
gGravity ❑ Pressure 0 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class SCH 3034
Daily Flow:Operating Capacity 180 gpd Length t4,;7,? 135 ft
Daily Flow: Design Flow 240 gpd Diameter 4 in
Septic Tank Capacity(working) 1200 gal Number 3
Receiving Soil Type(1-6) 4 Separation 5 (on center) ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 400 (t2 Total Number of Orifices nla-pert pipe or chambers
Designed Primary Area 3610 ft2 Diameter rt/a in
Designed Reserve Area 4200` ft2 Spacing n/a in
Trench/Bed Width 3 ft Manifold
Trench/l3ed Length 45 ft Schedule/Class n/a
Elevation Measurements Length n/a ft
Original Drainfield Area Slope 3-5 oio Diameter n/a in
New Slope,If Altered same % Preferred manifold configuration used? 0 Yes ❑No
Depth of Excavation Up-slope 8 in r , .. rt Pipe
from Original Grade Dort,-slope 6 in SPdP/t s V �''. SCH 3034
Designed Vertical Separation 18 in .Length , , 185 ft
Gravelless Chambers Required? 0 Yes 0 No Eif Optional Diameter t i',‘ 4 in
Pump Required? 0 Yes Ei'S No Dosing and Pump Chamber
Pump/Siphon Specifications Number ofddscs/day n/a-standard gravity
I)iff. in Elevation Between Pump&Uppermost Orifice n/a ft Dose quantity n/a gal
Drainfield Squirt Height/Selected Residual(head) n/a ft Chamber Capacity(flood) n/a gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure I lead n/a gpm OTimer DElapse Meter 0 Event Counter
Calculated Total Pressure Head _ n/a — ft If Timer: Pump on_ n/a .l'ump off Na
Comments
A reserve area (TH#3 &4) has been designed in the attenuation zone totaling 4200 sq/ft. Additional reserve
area (TH#5 & 6) for future expansion has been designed for this project and includes an additional 3010 sq/ft.
Dnnted From. Ma .Jn County 6
Printed from Mason County DMS
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 2 0 0 1 -- 7 6 -- 0 0 0 8 0
— —
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
0 Test hole locations Q! Drainfield orientation and layout Reference depth from original grade:
g Soil logs Eli Trench/bed dimensions and
g Septic tank
0 Property lines critical distances within layout QJ Drainfield cover
6d Existing and proposed wells g l)-Box/Valve box locations
Reference depth from original grade
within 100 ft of property g Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts, banks, and locations 12i Laterals, trench bed, top and
surface water and critical areas 671 Observation port location bottom
❑ Location and orientation of g Clean-out location 0 Curtain drain collector
curtain drain and ali absorption 0 Manifold placement ❑ Sand augmentation
components
fil 0 Orifice placement Other cross-section detail:
Location and dimension of
primary system and reserve area g Lateral placement with distance gObservation ports/clean-outs
g Buildings to edge of bed Other Information
0 Audible/visual alarm referenced Yes No
l21 Direction of slope indicator
g Scale of drawing shown on scale 0 g Design staked out
6d Waterlines bar 0 g Recorded Notices attached
g Roads,easements, driveways, g 0 Waiver(s)attached
parking 0 [To Pump curve attached
g North arrow and scale drawing 0 g Evaluation of failure
shown on scale bar Non-residential justification
❑ Elf Waste strength
❑ i 'Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer at time of installation g Yes 0
7 1/3(Z.7 vE
Signature of Designer Date
l202 f
y
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 " e regulations:
til-14Th 5--il-)_42.____
En r e a1 Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped "Approved" by Mason County Public Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: Lt/` ;-.l"
✓ 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
printed From Mason County D ..
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