HomeMy WebLinkAboutSWG2022-00575 - SWG Application / Design - 11/14/2022 H STREET,
i MASON COUNTY 415 N 6 SHE TON 3 0-427-9670,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: SWG2022-00575
APPLICANT LIPKE ET AL JOHN & LORI Phone: 630-242-0175
Address: 356 79th Place WILLOWBROOK, IL 60527
OWNER LIPKE ET AL JOHN & LORI Phone: 630-242-0175
Address: 356 79th Place WILLOWBROOK, IL 60527
SEPTIC DESIGNER Jim Hunter and Associates Phone: 360-753-1226
Address: PO Box 162 OLYMPIA, WA 98507
Site Address: E Mystic Ct
Primary Parcel Number: 421144390092
Permit Description: New 3bd pressure sand lined bed on easement
Permit Submitted Date: 11/14/2022
Permit Issued Date: 03/31/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $500.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 12/08/2025 (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 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.
7 Tanks not to be installed until Geo Report has been reviewed by County Planner and
building permit issued.
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/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
C . c
OFFICIAL USE ONLY
MASON COUNTY PUBLIC HEALTH DATE RECEIVED: 1 I • 14 •Vits.
to D
ONSITE SEWAGE SYSTEM APPLICATION AMOUNT R50 oel: RECEIVED v
415 N 6th Street,(Bldg 8) Shelton WA,98584 cn
Shelton:360-427-9670 ext 400 Belfair:360-275-4467 ext 400 sWG 2.it�'3,'�. - d e 'S 'IS-
Z fA
APPLICANT PHONE > D
JOHN LIPKE 630-242-0175 m m
MAILING ADDRESS-STREET.CITY,STATE.ZIP CODE r
356 79TH PLACE WILLOWBROOK IL 60527 z
SITE ADDRESS-STREET,CITY,ZIP CODE CO
XX MYSTIC LANE UNION WA 98592 m
NAME OF DESIGNER PHONE I•
JIM HUNTER 360-753-1226 �1)
NAME OF INSTALLER PHONE I �j/
CHECK ALL APPLICABLE ITEMS DRINKING WATER SOURCE 0
( -
" 1 sr NEW CONSTRUCTION ❑ (p RV HOLDING TANK ONLY ❑ PRIVATE INDIVIDUAL WELL
❑ REPLACEMENT SYSTEM ❑ INSTALLATION PERMIT ONLY ❑ PRIVATE TWO-PARTY WELL Z
❑ TABLE 9 REPAIR Wi SINGLE FAMILY COMMUNITY/PUBLIC WATER SYSTEM
❑ TANK(S)ONLY ❑ COMMERCIAL SYSTEM NAME:❑ I
UPGRADE TO EXISTING ❑ OTHER. BEDROOMS LOT SIZE Ic
❑ EXISTING FAILURE "Record Drawingrequired
r� °°n
for all Installations" 3 r
DIRECTIONS TO SITE-BE SPECIFIC AND ADVISE OF ANY NEEDED INFORMATION FOR ACCESS(ex.locked gate) 0 1
An c,'Rx-A' ( -Or,—r A ,.,axn3 4 •4•-...- cZ", L- —r r4.7 a L. X I-
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS I 9)
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE!FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ['BUILDING PERMIT ['HOME SALE ['COMPLAINT ['OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
0- (e) II\ S A...."
��c'�-`'\` ?J-t- yr\D Al /-��1`` �'�` 17/("
Dos,„...
�\
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED BY DATE
rl. in \z-(bl Z7. aIbil - e^l k2-,
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
DESIGN FORM-PAGE ONE Assessor's Parcel Number:A z t + -- 4 3 -- / 0 v 9 Z-
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.
Maximum paper size: 11"X 17"
P CEL IDENTIFICATION
Permit Number: SWG 'LOX/ADD r-7c Designer's Name: J t.A* c\v l-L-ets(L.
Applicant's Name: %IVA,t..+ L-t?_i Designer's Phone Number: 3 til 0 -'t S 3- l 22C.
Mailing Address: 3S(4:0 1 -cu P%,-A-c.r. Designer's Address: p .,o . lito•A- 1.(.0Z-
•tV tL-.1.o wRtic)t(- 1,1., Ms-1 GvPr 96So-1
City State Zip City State Zip
DESIGN PARAMETERS
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:_
Drainfield Type
❑ Gravity Pressure 0 Trench ❑Bed ❑ Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 4
Daily Flow:Operating Capacity ZZp gpd Length-- (� - 4 S ft
DailyFlow:Design Flow I p_i ti �? U V"�g 3(a t) gpd 1 lameter ( ZS in
Septic Tank Capacity Wit-1AsID t'La O gal 3
74R 3 0 2023 d
Receiving Soil Type(1-6) 3 1 Separation 3-3 3 ft
Receiving Soil Appl.Rate 0 .6 gpd/ft2 Orifices
Required Square Footage To IS.
q q g 4S0 ft2 -Total Number ofDn tees
Designed Square Footage 4 S'J ft2 Diameter 3/l(o in
Percent Reduction Taken % Spacing - s in
Trench/Bed Width 10 ft Manifold
Trench/Bed Length 4.S ft Schedule/Class 4-0
Elevation Measurements Length Gl•(a 1 ft
Original Drainfield Area Slope 0 t % Diameter Z in
New Slope,If Altered t.i. t A- % Preferred manifold configuration used? ((Yes 0 No
Depth of Excavation Up-slope q in Transport Pipe
from Original Grade Down-slope ci in Schedule/Class 4 o
Designed Vertical Separation 24 in Length 2'49 ft
Gravelless Chambers Required? Yes 0 No 0 Optional Diameter `Z- in
Pump Required? C,Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day (p
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity tito gal
Orifice (.t..2S- ft Chamber Capacity (`ti-Ov gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 32, 3 o Co gpm Eimer &lapse Meter \Event Counter
Calculated Total Pressure Head l' . 4't't- ft If Timer: Pump on ,Pump off
Comments -cv(b tonivvve+f er t, 1 t 6
0
' DESIGN FORM—PAGE TWO Assessor's Parcel Number: I'll a 1 1 y -- y 3 -- l 0 0`1 G
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
❑ Test hole locations 0 Drainfield orientation and layout Reference depth from original grade:
❑ Soil logs 0 Trench/bed dimensions and 0 Septic tank
❑ Property lines critical distances within layout ❑ Drainfield cover
❑ Existingand proposed wells 0 D-Box/Valve box locations
P P Reference depth from original grade
within 100 ft of property 0 Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts, banks,and locations 0 Laterals,trench bed,top and
surface water and critical areas 0 Observation port location bottom
❑ Location and orientation of 0 Clean-out location 0 Curtain drain collector
curtain drain and all absorption ❑ Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
❑ Location and dimension of 0 Lateral placement with distance 0 Observation ports/clean-outs
primary system and reserve area to edge of bed
❑ Buildings Other Information
0 Audible/visual alarm referenced Yes No
❑ Direction of slope indicator 0 Scale of drawing shown on scale 0 0 Design staked out
❑ Waterlines bar 0 0 Recorded Notices attached
❑ Roads,easements,driveways, 0 0 Waiver(s)attached
parking 0 0 Pump curve attached
❑ North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑ Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be notif-d is a/at time of installation 0 Yes KNo
Signal's = 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-site regulations:
Environmental 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: r2I �IL�
✓ 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
• PAGE1
MASON COUNTY HEALTH DEPARTMENT
ON-SITE SEWAGE DISPOSAL SYSTEM DESIGN
SITE#: PARCEL#: 42114-43-90092
DATE SUBMITTE 03/23/23 LEGAL/LOT#: SP#2296
LOT 2
SUBMITTED BY: JIM HUNTER
A PpR
APPLICANT: JOHN LIPKE 0 VED
ADDRESS: 356 79TH PLACE
WILLOWBROOK, IL MASON MAR 3 2023
COON TY EN VIRI.
I.CALCULATIONS REr ENrAL HEATH
NUMBER OF BEDROOMS = 3
RESIDENTIAL GPD FLOW= 360
IF NON-RESIDENTIAL-GPD FLOW
WILL BE AS FOLLOWS:
GPD=
APPLICATION RATE= 0.8 GPD/FT2
REDUCTION =LEAVE BLANK IF NO REDUCTION TAKEN
DRAINFIELD SIZING
ABSORPTION AREA= 450 FT2
TRENCH LENGTH OR BED CONFIG.= 10'-0"X 45'-0"
II.WATERPROOF SEPTIC TANK
COMPOSITION AND SIZE = 1200 GAL.CONCRETE
NEW OR EXISTING= NEW
III. DRAINFIELD CROSS SECTION
DEPTH TO DRAINROCK BOTTOM= N/A GRAVELLESS CHAMBERS
ROCK DEPTH BELOW PIPE= N/A GRAVELLESS CHAMBERS
SEPARATION FROM TRENCH BOTTOM TO IMPERMEABLE
MATERIAL/SEASONAL SATURATION= >2'-0" --
FILL DEPTH = 1'-0"
TRENCH WIDTH = N/A
IV. PUMP REQUIREMENT
DOSING VOLUME IN GALLONS = 60
NUMBER OF DOSES PER DAY= 6 <<
V. PRESSURE CALCULATIONS
USING PIPE CLASS 40 ••
ORIFICE 3/16 ;yr%' 1: ��
t ,� z ti
S.i nF ClrdyrR -S ,�
• %22/2
•
PAGE 2
LATERAL#1 =
SQUIRT HEIGHT(FT) 3.00
(NOTE(2).ORIFICE DISCHARGE RATE=(11.79)X(ORIFICE DIAMETER)SQ2 X
11 SQ ROOT OF(TOTAL PRESSURE HEAD)
ORIFICE DISCHARGE RATE= 0.71792
LATERAL LENGTH IN FEET= 45.00
ORIFICE SPACING= 1'9"
DISTANCE FROM END CAP= 1'6"
NUMBER OF HOLES = 25
LATERAL DISCHARGE RATE = 17.948
LATERAL#2=
SQUIRT HEIGHT(FT) 3.00
ORIFICE DISCHARGE RATE= 0.71792 4 D[") n O V E
LATERAL LENGTH IN FEET= 45.00 f r (� D
ORIFICE SPACING = 1'9"
DISTANCE FROM END CAP= 1'6" MAR 31 2023
NUMBER OF HOLES= 25 MASON COUNTY ENVIRONMENTAL HEALTH
LATERAL DISCHARGE RATE= 17.948
RET
LATERAL#3=
SQUIRT HEIGHT(FT) 3.00
ORIFICE DISCHARGE RATE= 0.71792
LATERAL LENGTH IN FEET= 45.00
ORIFICE SPACING= 1'9"
DISTANCE FROM END CAP= 1'6"
NUMBER OF HOLES = 25
LATERAL DISCHARGE RATE = 17.948
LENGTH DIAMETER FLOW FRICTION LOSS
SECTION (FT) (IN) (GPM) (FT)
AB 248.00 2.00 53.844 11.403
BC 1.80 2.00 35.896 0.039
CD 3.40 2.00 17.948 0.020
DE 45.00 1.25 17.948 1.936
TOTAL= 13.398
**TOTAL HEAD LOSS **
1)FRICTION LOSS THROUGH SYSTEM = 13.398
. 2)ELEVATION DIFFERENCE = 6.250
tt''. , :`'I. .(. 1'•
1� \ CL 3)RESIDUAL = 3.000
,`` n sj , TOTAL = 22.648
47 0, p\M It !INTER '+It`
Iv-t ;.y)►**.N!R
13;Piz'1ES: 03/22/
MYERS MESSO, MESIOO SERIES
APPROVED
MAR 31 2023
MASON COUNTY ENVIRONMENTAL HEALTH
RET
• CAPACTY L(TERS PER MINUTE
ICC
EMI
90
11r1l00
L ■■
Z 60 Z ,
ecfs0
40 -� O
10 mil
b� '80 (00 —f20
•
CAPACITY GALLONS PER MINUTE
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O�� 51007 ��•
j4Ff15 R.HOOTER S 11
AP 1lrrokjsEb bESPCNER ' 1�
;PrfIS: O3/22/
�� t5421-fiZ4b
' 554126 GRANT OF EASEMENTS
l This grant of easements is made this 29th day of October, 1992, by Michael E. Fox and Anita R.
AfHDAVITFox, husband and wife to establish easements for septic tanks, drainfields and reserve areas,
No. - together with the t of,�,,R�,,,,,,,f right ingress and egress to install,maintain,repair and/or replace said systems.
T uc;('Ax This easements shall cover that portion of Lot 1 of Short 't. No. 497,recorded March 20, 1977,
E X E M Ptihder Auditor's File No. 358509,as shown on the attached' Exhibit"A",which shall become
OCT 2 9 ,�,�,gart if this easement by reference hereto.
�y�7LL L ___
DORENE R lgtese easements shall be for the benefit of pie... ,.22 and 3 of pending Short Plat of the
Trc ,..Moon Co1111,.operty described herein on Exhibit"C"and as ,xiMately shown on attached map Exhibit
"B", which maps shall become a part of this easemeeference hereto.
An additional easement for piping and Mill.' togeth� �vittt the right of ingress and egress to
install. maintain repair and/or replace said . . dies is hereby established over the South 5
feet of proposed Lot 1 of the pending Short Plat'of property described herein on Exhibit"C"and
as shown on attached map Exhibit"B ,which shall become a part of this easement by reference
hereto. �\ )
This easement shall be for the benefit of proposed Lot 3 of the pending Short Plat of the Property
described herein on Exhibit"C"and as shown on attached map Exhibit"B".
These easements shall run tle to said proposed lots and shall not be assignable to any
other property.
�`arit�a.(i
/' 4 ---
MtchaeTE.Fox Anita R.Fox
STATE;OF N
CO OF Q
On thin sty of October, before me, the undersigned a Notary Public in and for the State of
Was . 'duly commissioned and sworn, personally appeared Michael E. Fox, to me known to
be,the itlVidual described in and who executed the forgoing instrument for their self and as
' 4 .in fact of Anita R. Fox, also therein described, and acknowledged to me that he signed
the same as his voluntary act and deed and as the free and voluntary act and deed of the
said R. Fox,for the uses and purposes therein mentioned, and on oath stated that the power
of�authorizing the execution of this instrument has not been revoked and that the said
Attita�Fox,is now living.
SS my hand and official seal hereto affixed the day and year in
` • certificate above written.
r Y r-)
ary bile in and or the State of `
Washington, residing at_
My commission expires 11— (9—et 4
G� -
XoN,' rzOCT29 f,ti.ic 8 35 ''-0i':>t.1.R.Z.)kiE-* -C
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7.6 W.RAILROAD AVE•P.O.SOX Z•SHELTO".WA 66664
SHELTON O06)4261616•■RE/PENTON(206)377.6017
FAX(206)428.9493
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[�hkb14- L REEL 542FR249`
SHORT PLAT NO:
APPROVED:
g�
DIRECTOR OF GENERAD�+ g\,VICES
PLANNING DEPARTMENtNN
TOTAL TRACT: kliir/2----7
THAT PORTION OF THE SOUTH HALF OF—THE SOUTHEAST QUARTER OF SECTION
14, TOWNSHIP 21 NORTH, RANGE `WEST W.M. , IN MASON COUNTY,
WASHINGTON, DESCRIBED AS FOLLOWS:
BEGINNING AT A POINT ONTHE.NORTH LINE OF SAID SOUTH HALF, SOUTH
89 DEGREES 22'05" EAST 89304/FEET FROM THE NORTHWEST CORNER OF THE
SAID SOUTH HALF; THENCE—CONTINUE SOUTH 89 DEGREES 22'05" East
134.75 FEET; THENCE S�TH '20 DEGREES 48'09" EAST 829.10 FEET;
THENCE SOUTH 89 DEGREE <59' 35" WEST 429.20 FEET, MORE OR LESS, TO
A POINT WHICH LIES SOU OF THE POINT OF BEGINNING; THENCE NORTH
776.59 FEET TO THE POb4' OF BEGINNING.
T CT 1: \\ /i'
TH POR , • ' 0 E/
AT SIU H HALF OF 'E SOUTHEAST UAR+ ER OF SD TION
14, TOW . ' 21 NORTH RANGE • WE T W.M. , IN •SON C•'NTY,
WASH NG • i4 SCRIBE• A FOLLOWS.
N.
BEGIN. NG AT PO T ON E NS'TH LINE F S ID SOUTH A , SO TH
89 D ES 22'0• " AST 893. 04 : ET FROM T E RTHWEST' Co' R OF
SAt• •+ TH HAL THENCE •N INUE SOUTH 8 DEGREES 2'•'05" Ea.
13 .75 • •ET; T CE SOUTH % DEGREES 48' " EAST 829. • FEET '•
T ',TRUE •OINT OF BEGINNIN ; THENCE NORT 20 DEGREES 48'09" W S
1•3:64-- E ; T ENC= NORTH 6' • GREES 59'4 " EST 25.69 EE ; TH•NCE
-- -O 81 D G' •ES 51 '50" W ST •0.53 FEE ; T ENCE SOU H 66 DEGREES
4145 " WES .6.29 F:ET; 1 ENCE SOUTH 5 DEG ES 13' 08" WE'T 92.37
FEET; THENC•, SOUTH 1. D' REES • 4'33" EST 6 .78 F2 T, TO POINT
WEST OF TH• P•INT OF n G. NNING; ENCE NORTH 8 DEG EES 59' " EAST
239.40 FED , ORE OR • SS, TO TH. TR E POINT F BEGINNING
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