HomeMy WebLinkAboutSWG2022-00370 - SWG Application / Design - 6/27/2022 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
ea: SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
—f` Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2022-00370
APPLICANT IDDINGS, EARL J Phone: 206-391-7502
Address: PO BOX 2755 BELFAIR, WA 98528-2755
OWNER ITS YOUR HOME LLC Phone:
Address: P 0 BOX 2755 BELFAIR, WA 98528
SEPTIC DESIGNER ANTHONY DEMIERO Phone: 360-877-5200
Address: PO BOX 1174 HOODSPORT, WA 98548
Site Address: 431 NE Hurd Rd
Primary Parcel Number: 322242390081
Permit Description: New SFR - 3BR Pressure
Permit Submitted Date: 06/27/2022
Permit Issued Date: 03/27/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $740.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 07/12/2025 (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 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.
C• C
OFFICIAL USE ONLY
DATE RECEIVED.
MASON COUNTY a �.� 27
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COMMUNITY SERVICES AMo . RECEIVED CO N
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Public Health(Community Health/Environmental Health) 'C
360427 9670.ext.400 or 360-2 7 5 4467.ext 400 ((��'' /� /'' /w�� to
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ON-SITE SEWAGE SYSTEM APPLICATION 3
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APPLICANT PHONE 1
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE /� E
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SITE ADDRESS-STREET,CITY,ZIP CODE
' ' ' 64-, (-{LJ rc! JQ d i I(-)4
NAME OF DESIGNER PHONE IV
6/. f{rt_ro • 36O-i71-52,7 /
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NAME OF I ALLER PHONE 0 I/`"
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PERMIT E(select one) DRINKING WATER SOURCE O
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�I[RESIDENTIAL OSS COMMUNITY OSS E COMMERCIAL OSS ff PRIVATE INDIVIDUAL WELL 6 PRIVATE TWO-PARTY WELL Z
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TYPE OF WORK(select one) PUBLIC WATER SYSTEM
Iiii NEW CONSTRUCTION/UPGRADES REPAIR!REPLACEMENT OT6ET.Aft37setecralfMwLaQP/Y inTABLE IX REPAIR I/1
SUBMITTALS /H5.II SURFACING SEWAGE ❑E TING FAILURE 0 SHORELINE W
EDESIGN FORM(REQUIRED) *SEPTIC DESIGN(REQUIRED) S LOT SIZE r 103
0
WAIVER(S)(IF APPLICABLE) 3 3gfx 5zc 0 t
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) at, V,� 61 u r-L Rd 6�I4 k -� s IA eto ptirp(� igIt rlt h
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. 1--
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY in MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS V,/ I�„y`,N�/ COMMENTS/CONDITIONS
--3y 5' v''... a- -•. --7--
17(, p r
*. ..6) L 5
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1 01-0
RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E x EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSP TOR SIGNATURE DATE APPLICATION EXPIATION DATE APP TION APPROVED/ISSUED BY DATE
j:i.L1 J' --17 - Z3 4 7 t2-25 W ,A -Z7 -2
T AY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
DESIGN FORM-PAGE ONE Assessor's Parcel Number:,_2_2_ -- 2_3 -- 1 a. 1_-I-
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"
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PARCEL IDENTIFICATION I
Permit Number: SWO 2o2Z' m0 37C) Designer's Name: 4. r . 1-7.
Applicant's Name: G.rt Y d 4.,r0S .- ,rse d Designer's Phone Number: 3(( ?17- 5 Z 1 7
Mailing Address: Po aai 275 5 Designer's Address: d dog t i 1'
,Be 1 Cr (,.ICIlt.. �j'7518" km4ces-4 g.)k. gfY6y S
City State Zip City State Zip
DESIGN PARAMETERS
Treatm t Device
❑Glendon Biofilter 0 Sand Filter 0 Mound . ed Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfec ion Unit Make/Model Other:
Drainfield Type
❑Gravity iiiil Pressure -1111 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class SGN
Daily Flow:Operating Capacity .36 0 gpd Length 6 7 ft
Daily Flow:Design Flow 3 6 O gpd Diameter /,0 in
Septic Tank Capacity(working) Ilo D gal Number , 3
Receiving Soil Type(1-6) Y Separa ' •..•., /2— ft
Receiving Soil Appl.Rate , C gpd/ft2 `.7 Orifices
Required Primary Area ZdOt I6d0Z ft2 T umlier•:¢. 'fives /G
Designed Primary Area 61)o ft2 l iaindtet 1
;�'' ' •'•s� fh i in
ice'%:^ d
Designed Reserve Area l a A' ft2 ,As,o , .'S. .36 I in
e v • E
Trench/Bed Width 3 ft i/ 1„'si;n' J r2 I "' Manifold
Trench/Bed Length 67$ ft Schetinickisi o S-t5' q p
Elevation Measurements Length 6 ft
Original Drainfield Area Slope ZSJ o Diameter ,2.6 in
New Slope,If Altered s p prArrOn1VfE
tion used? IQYes ❑No
Depth of Excavation Up-slope ransport Pipe
from Original Grade Dorm-slope ? RjZal s 'Ed
Designed Vertical Separation illr�
�- L.f MAbnAi r` t1NT NMENT
HEALTH o ft
� AL
Gravelless Chambers Required? Yes 0 No 0 Optional r 2.0 in
Pump Required? .iiii Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day C
Duff.in Elevation Between Pump&Uppermost Orifice /t9 ft Dose quantity 60 gal
Drainfield Squirt Height/Selected Residual(head) /`1 ft Chamber Capacity(flood) (aoo gal
Uppermost Orifice ill Higher 0 Lower than Pyimp Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 38,141 gpm f77Timer 5Elapse Meter in Event Counter
Calculated Total Pressure Head C ft If Timer: Pump on h-sY t ,Pump off ../lrs
Commentt(E,(cu,e-r-I E-) 1.5`f i S -f t-e- c - J-- -9 co,.3 -{^er -17W2r- .hO be 5.= q-/ .
46't6OS S.,tg is -(-ar� e€,0i1"e1) ?esrt..l ab 6e ivisJo11cd w:4-c, 4.4.e. Sys ka
DESIGN FORM-PAGE TWO Assessor's Parcel Number: - --
• Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
j1 Test hole locations V Drainfield orientation and layout Reference depth from original grade:
V Soil logs V Trench/bed dimensions and ,l Septic tank
critical distances within layout
�' Property lines JZ Drainfield cover
All.1 Existing and proposed wells 11 D-Box/Valve box locations Reference depth from original grade
within 100 ft of property jd Septic tank/pump chamber and restrictive strata:
or Measurements to cuts,banks,and locations Laterals,trench/bed,top and
surface water and critical areas 12f Observation port location bottom
Ca Location and orientation of 9r Clean-out location 0 Curtain drain collector
curtain drain and all absorption Q" Manifold placement 0 Sand augmentation
components
0 Orifice placement Other cross-section detail:
91 Location and dimension of Qf Lateral placement with distance 0 Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
Ci Buildings 0 udelegsa#aanhn referenced Yes No
0. Direction of slope indicator afro n , , 0 0 Design staked out
0 Waterlines ❑ 0 Recorded Notices attached
6 Roads,easements,driveways, MAR 2 7 2023 ❑ 0 Waiver(s)attached
parking MASON COUNTY ENViRONM 0 Q'Evaluation of p curve attached
9 North arrow and scale drawing Jew ENTgL HEALTH
shown on scale barNon-residential justification
❑ Ef Waste strength
A ❑Flow
DESIGN APPROVAL
The undersigned designer must be •fled •157
stal r at time of installation &Yes 0 No
t1-IZ-Lo?L
Signature of Designer 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 on- 'te regulations:
1.7
En • o i tal 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: -2 t 2-21
I 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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