HomeMy WebLinkAboutSWG2022-00607 - SWG Application / Design - 12/8/2022 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,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: SWG2022-00607
APPLICANT ROATS-HUBBARD TRUST Phone:
AGREEMENT
Address: 23411 Rhododendron Lane POULSBO, WA 98370
OWNER ROATS-HUBBARD TRUST Phone:
AGREEMENT
Address: 23411 Rhododendron Lane POULSBO, WA 98370
SEPTIC DESIGNER Jim Zimny -Advantage Perc & Design Phone: 360-516-7287
Address: 7178 WINDFLOWER PL NW SEABECK, WA 98380
Site Address: UNKNOWN
Primary Parcel Number: 223365300099
Permit Description: New 2bd pump to gravity bed with location waiver
Permit Submitted Date: 12/08/2022
Permit Issued Date: 04/07/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $500.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 12/16/2025 (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/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY C• C.
DATE RECEIVED:
MASON COUNTY 1 10 9 f 2.C) O N
COMMUNITYfin T I CO 0
SAIL N. % I��,AMOUiT1Et �JOU RE�IVEDBY: �� c fAM
Publk (Community
415 N 6th Street
et t.-4e a n,WA 13584 ext 400 , L, SING �0�.a. - 00 b01- z x
a,sKemsneet-Shero�,wAssssa �, DEC 0 8 2022
CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION D D
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APPLICANT PI-ZONE m
GREG ROATS 360-509-3201 r
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MAILING ADDRESS-STREET.CITY,STATE,ZIP CODE 5 3'
23411 Rhododendron Lne, Poulsbo WA 98370 00
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SITE ADDRESS•STREET,CITY,ZIP CODE /
Babra Blvd, Belfair WA IN
NAME OF DESIGNER PHONE
Jim Zimny 360 516-7287 C I(\
NAME OF INSTALLER PHONE v I
DRINKING WATER SOURCE
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PERMIT TYPE(select one) 0
M RESIDENTIAL OSS h COMMUNITY OSS fl COMMERCIAL OSS n7 PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL lz c—
TYPE OF WORK(select one) 1^'
la PUBLIC WATER SYSTEM Lynch Cove
W NEW CONSTRUCTION I UPGRADES hREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR U v I , A
v )
SUBMITTALS CISURFACING SEWAGE ElEXISTING FAILURE ❑SHORELINECO
DESIGN FORM(REQUIRED) IP)SEPTIC DESIGN(REQUIRED) BEDROOMS 2 LOT SIZE .17 acres g I W
R.WAIVER(S)(IF APPLICABLE) n (
DIRECTIONS TO SITE AND SITE CONDITIONS(ex locked gate) \/
from Belair go 3.4 miles down North Shore rd to Larson Lake RD and go rt. I O
1 in 250 ft take ft on Mathew dr., in 2 mi take rt on Barbra Blvd. in 700 ft lot in on the rt.
Marked with pink Ribbons) Across from 320 Barbra Blvd C
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS I CONDITIONS
b -( D I.JWSV/
, , 1°ram
92 6 -S 6 1w S CI? t Slo
VI 0 --3-co, .eft, 1 LI/7/z3
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.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12fl/2015
I'
DESIGN FORM—PAGE ONE Assessor's Parcel Number. 223365300099- --
A design will be reviewed when 3 conies 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 1 7„
PARCEL IDENTIFICATION
Permit Number. SWG 2.v22..— O 0 bet Designer's Name: Jm Zimny
Greg Roats 360-516-7287
Applicant's Name: P- '�� si•er:
23411 Rhododendron lane n � C; E 7178 Windflower pl NW
Mailing Address: l ,��
Potisbo,WA 96370 +'1 DEC 0 8 2022 Seebeck WA 98380
CLEAR FORM
City State Zip City State Zip
DESIGl 1q4RAMETERS
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield ❑Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
4 ErGravity 0 Pressure 0 Trench fieBed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class 3034
Daily Flow:Operating Capacity 180 gpd Length 30 ft
Daily Flow: Design Flow 240 gpd Diameter 4 in
Septic Tank Capacity(working) 1200 gal Number 3
Receiving Soil Type(1-6) 3 Separation 3' ft
Receiving Soil Appi.Rate 0.8 gpd/ft2rifices
Required Primary Area 300 ft2 Total Number of Orifices N/a
Designed Primary Area 300 ft2 Diameter ��t in
Designed Reserve Area 300 ft2 Spacing A Viiit in
,t
Trench/Bed Width 10 ft �f` tt ► anifold
'�, ;itt N/a
Trench/Bed Length 30 ft Schedule/C '; '�
oz i
Elevation Measurements Length L>. � RW• ft
Original Drainfield Area Slope 1 % Diameter Expues:8l1' in
New Slope,If Altered 1 % Preferred manifold configuration used? 0 Yes It No
Depth of Excavation up-slope 18 in Transport Pipe
from Original Grade Down-stop, 18 in Schedule/Class sch 40
Designed Vertical Separation 36 in Length 68' ft
Gravelless Chambers Required? 0 Yes el No 0 Optional Diameter 1 1/2 in
Pump Required? El Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 4
Diff. in Elevation Between Pump&Uppermost Orifice 20 ft Dose quantity 45 gal
Drainfield Squirt Height/Selected Residual(head) 2 ft Chamber Capacity(flood) 1000 gal
Uppermost Orifice E'Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity a,Total Pressure Head 15 gpm EtTimer lftlapse Meter !8'Event Counter
Calculated Total Pressure Head 30 ft If Timer: Pump on 1.5 ,pump off 6 hrs
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number. 223365300099— —
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
P1 Test hole locations le Drainfield orientation and layout Reference depth from original grade:
el Soil logs Et Trench/bed dimensions and Er Septic tank
le Property lines critical distances within layout lid Drainfield cover
✓ Existing and proposed wells V D-Box/Valve box locations Reference depth from original grade
within 100 ft of property El Septic tank/pump chamber and restrictive strata:
0 Measurements to cuts,banks,and locations EJ Laterals,trench/bed,top and
surface water and critical areas 121 Observation port location bottom
121 Location and orientation of B 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:
E1 Location and dimension of E( Lateral placement with distance V Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
fg Buildings
E1 Audible/visual alarm referenced Yes No
Q Direction of slope indicator Er Scale of drawing shown on scale 0 le Design staked out
Er Waterlines bar ❑ V Recorded Notices attached
PJ Roads,easements,driveways, �i� Lol 0 Waiver(s) attached
parking F� • I. 7 0 Pump curve attached
Er North arrow and scale drawing ." .�� /'';� _ ❑ CI Evaluation of failure
shown on scale bar e, ,.1
Non-residential justification
Oc ' n . ❑ 0 Waste strength
`,.oES:GNER ❑ 0 Flow
DESIGN OVAL
The undersigned designer must be noti bi ,icime of installation el Yes 0 No
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Sign . o signer 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. / S
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: 7 ` `' 1
✓ 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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Advantage Perc & Design
Timely-Reasonable-30 Years of Local Experience
Construction Notes fat j bedroom Gravity bed System
-Install 10'x 30' bed 18"deep on high side of trench with a d-box and equal distribution configuration
-must verify and maintain 36" of vertical separation.
-Install level and along contours.
-Install in dry weather only.
-Use 1200 Gallon septic tank and pump tank w/counter,timed dosed and audio &visual high water
alarms
-System designed for typical residential waste strength sewage only.
-System designed for 360 Gallons Per Day
APPROVED
APR 0 7 2023 =P9f4 '0
MASON COUNTY ENVIRONMENTAL HEALTH = 20123
Advantage Perc&design • APDdesiensfalicloud.com • (360) 516-7287
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Pump Specifications , ; . 1
280 Series 1 /2 lip
Submersible Effluent Pump
LITERS PER IIMNTE
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