HomeMy WebLinkAboutSWG2022-00620 - SWG Application / Design - 12/19/2022 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
L BELFAIR:360-275-4467,EXT 400
_... Public Health & Human Services ELMA:360-482-5269,EXT400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2022-00620
APPLICANT Ben Jennings Phone:
Address: PO Box 1174 BELFAIR, WA 98528
OWNER TAYLOR/ LYNX CONSULTING Phone: 1.206.972.1368
Address: 17311 135TH AVE NE STE A-100 WOODINVILLE, WA 98072
SEPTIC DESIGNER ROD LEFT-Acme Design Phone: 360-509-2000
Address: PO Box 2954 SILVERDALE, WA 98383
Site Address: UNKNOWN
Primary Parcel Number: 321262394001
Permit Description: New SFR-4BR Gravity W/ Class B Waiver
Permit Submitted Date: 12/19/2022
Permit Issued Date: 04/03/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $500.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 01/06/2026 (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.govlhealth/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
•
OFFICIAL USE ONLY-- —C
—
DATE RECEIVED:
-`% , MASON COUNTY \ 2 l z o z u, cn
.I(. ''1I COMMUNITY SERVICES AMOUNT REC P.� RECEIVED BY, pa CO m
r -� Public Health(Community Health/Environmental Health) (n
„----, 415 N.6A6)e.ext<OO a 3l WA 98546],tat 400 S W G 2 D)a - (0 6 ZO 0 o
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ON-SITE SEWAGE SYSTEM APPLICATION
m
APPLICANT PHONE m
BEN JENNINGS __ c
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE K
PO BOX 1174 BELFAIR WA 98528 m
70
SITE ADDRESS-STREET,CITY,ZIP CODE
E MASON LAKE RD GRAPEVIEW WA 98546 10
NAME OF DESIGNER PHONE I9-)
ROD LEFT - ACME SEPTIC DESIGN 360-698-8488
NAME OF INSTALLER PHONE a
R.
PERMIT TYPE(select one) DRINKING WATER SOURCE 0
IyiERESIDENTIAL OSS ECOMMUNITY OSS ECOMMERCIAL OSS 6 PRIVATE INDIVIDUAL WELL WC PRIVATE TWO-PARTY WELL Z Il
M PUBLIC WATER SYSTEM
TYPE OF WORK(select one)
IF NEW CONSTRUCTION I UPGRADES 5 REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR 1` 1Ni
SUBMITTALS ❑ SURFACING SEWAGE ❑EXISTING FAILURE ❑SHORELINE
p �; I l3`t
DESIGN FORM(REQUIRED) RSEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE
gWAIVER(S)(IF APPLICABLE)
4 2,187,147.6 SOFT o
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) n
I
SEE MAP
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I ,----
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT El HOME SALE 0 COMPLAINT 0 OTHER'
INSPECTOR SOIL LOGS COMMENTS!CONDITIONS
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21`� b i
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RECORD DRAWING AND INSTALLATION REPORT 1
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL
INSP OR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLaTION APPRO DV ISSUED BY DATE
! 144 1.' o). I G -24 _ x5 ( ` .44 �� " S -2)
•
THI F&-/ AY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 1217f2015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 1 2 6 — 2 0 — 0 4 0 0 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.Maximum paper size: 11"X 17"
Permit Number: SWG 2.0)-1— DO 6 20 Designer's Name: ROD LEFT-ACME SEPTIC
BEN JENNINGS Desi er's Phone Number: 360-698-8488
Applicant's Name: !
Mailing Address: PO BOX 1174 Designer's Address: P.O.BOX 2954
BELFAIR WA 98528 SILVERDALE WA 98383
City State Zip City State Zip
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
I'Gravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4 Schedule/Class 40
Daily Flow:Operating Capacity 480 gpd Length 55 ft
Daily Flow:Design Flow 480 gpd Diameter 4 in
Septic Tank Capacity 1250 gal Number 5
Receiving Soil Type(1-6) 4 Separation 5 ft
Receiving Soil Appl.Rate .6 gpd/ft2 Orifices
Required Primary Area 800 ft2 Total Number of Orifices
Designed Primary Area 800 ft2 Diameter in
Designed Reserve Area 800 ft2 Spacing in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 270 ft Schedule/Class
Elevation Measurements Length ft
Original Drainfield Area Slope 3-4 % Diameter in
New Slope,If Altered 3-4 % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slope 14 in Transport Pipe
from Original Grade Do -slope 12 in Schedule/Class 40
Designed Vertical Separation 18 in Length 50 ft
Gravelless Chambers Required? 0 Yes 0 No I 'Optional Diameter 4 in
Pump Required? 0 Yes 66 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity gal
Orifice N/A ft Chamber Capacity gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head gpm ❑Timer ❑Elapse Meter 0 Event Counter
Calculated Total Pressure Head ft If Timer: Pump on ,Pump off
Comments
PPROVE r5•c
APR 0 3 2023 ! .r
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
23 cry-,0(
DESIGN FORM-PAGE TWO Assessor's Parcel Number:3 2 1 2 6 ---2--0- o -Q'--n
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
O Test hole locations Iii Drainfield orientation and layout Reference depth from original grade:
21 Soil logs El Trench/bed dimensions and 21 Septic tank
1 Property lines critical distances within layout 1 Drainfield cover
• Existing and proposed wells D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 1 Septic tank/pump chamber and restrictive strata:
21 Measurements to cuts,banks,and locations 1 Laterals,trench/bed,top and
surface water and critical areas 0 Observation port location bottom
Cl Location and orientation of 0 Clean-out location 0 Curtain drain collector
curtain drain and all absorption 0 Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
• Location and dimension of ❑ Lateral placement with distance 11 Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
21 Buildings 0 Audible/visual alarm referenced Yes No
FA Direction of slope indicator 21 Scale of drawing shown on scale 0 It Design staked out
0 Waterlines bar 0 21 Recorded Notices attached
O Roads,easements,driveways, 21 0 Waiver(s)attached
parking 0 21 Pump curve attached
O North arrow and scale drawing 0 10 Evaluation of failure
shown on scale bar Non-residential justification
❑ 1 Waste strength
❑ 21 Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer at time of installation 56 Yes 0 No
,�'L�f'
15 Nov ao.�.
Sign a 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 o ere: ations:
i.1A-1\-)1. (./. 3 3
� l ill:
En o ie 1 Heal Specialist Date
CAUTION: DESIGN APPR VAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. Z.
✓ �(p The Onsite Sewage Permit has not expired,the Permit Expiration Date is: Y
✓ 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 obta' Oolik16Q4 County Public Health.
V E .. - „.
An Installation Fee is required. , APR d 33 4, '
This form may be scanned and available for public., �r on the Mason Coun �'' -b site.
t,OUNTY ENUIRONib1ENTAL HEALTH Updated Date: 12/7/2015
JBW
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