HomeMy WebLinkAboutSWG2022-00606 - SWG Application / Design - 10/8/2022 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
J L 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: SWG2022-00606
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: 223365300098
Permit Description: New 2bd pump to gravity bed with local 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 inspectior)
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.
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
MASON COUNTY ���� 2 ' 2)2Z
COMMUNITY SERVICES AM REED g2 RECEIVED BY:
SODye CO >
v_ m
Pubtk Health(Community Health/Environmental Health) (n
0
32_9670.exL 400 Or36bI75 4467.e R 400 SWG Z 7 2 — (),(p & - °
415 N.bth Sty eet-Shelton,WA 98584
Z vi
CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION vXli
sP-
m 0
rn
APPLICANT
PHONE
GREG ROATS 360-509-3201 t-- r
- c
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE , W
23411 Rhododendron Lne, Poulsbo WA 98370 C' al
SITE ADDRESS-STREET,CITY,ZIP CODE
Babra Blvd, Belfair WA ^ I
NAME OF DESIGNER PHONE G
Jim Zimny 360 516-7287 c I N
NAME OF INSTALLER PHONE v I V V
C_
PERMIT TYPE(select one) DRINKING WATER SOURCE S I V
W RESIDENTIAL OSS COMMUNITY OSS In COMMERCIAL OSS r7 PRIVATE INDIVIDUAL WELL b PRIVATE TWO-PARTY WELL Z I^
TYPE OF WORK(select one) 2- PUBLIC WATER SYSTEM Lynch Cove $ O
1
W NEW CONSTRUCTION/UPGRADES C7 REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE IX REPAIR L/\) I(/),
SUBMITTALS 0 SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINE 03
W.DESIGN FORM(REQUIRED) PI SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r
W WAIVER(S)(IF APPLICABLE) 2 .17 acres Oo t
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex lacked gale)
from Belair go 3.4 miles down North Shore rd to Larson Lake RD and go rt. Ir`
in 250 ft take ft on Mathew dr., in 2 mi take rt on Barbra Blvd. in 700 ft lot in on the rt. r
Marked with pink Ribbons) Across from 320 Barbra Blvd o ID
GC � d _z) I-c>
DEC 0 8 2022 (Y ICE
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. —11
OFFICIAL USE ONLY BELOW THIS LINE - B=
UPGRADE/FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE OCOMPLAINT ['OTHER:
INSPECTOR SOIL LOGS COMMENTS I CONDITIONS
\ \ 0 --q b l 1 Lk °Jt mo
2 0 .,s-U �1n'� I a
* ‘, 4
-So--.? c (51opL
to sr_e_vAiNk ale.
p-✓ \( l Lr(7IZ3
R CORD 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
) i1 \Z I k I Z Iz l 16I 2c V11' 1-7 i i 1
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/712015
• DESIGN FORM—PAGE ONE Assessor's Parcel Number. 223365300098- — f)_a_C:
A design will be reviewed when 3 copies of each of the following are submitted:
v 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: II"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG 26 22 — 60 Le 64 Designer's Name: Jm Zimny
Applicant's Name: Greg Rows Designer's Phone Number: 360 516 7287
23411 Rhododendron lane g Jt'
ll� 7178 Windflower pl NW
Mailing Mail Address: Des►
Poulsbo,WA 98370 ' Seabeck WA 98380
CLEAR FORM -- r i DEC 0 8 2022 L
City State Zip city $rate zap
,0I y&lC�j�— t- DESIGN PA ETERS
'U Treatment'D*vtCE
❑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
E 'Gravity 0 Pressure 0 Trench lifBed 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 Appl.Rate 0.8 gpd/ff Orifices
Required Primary Area 300 f12 Total Number of 0 . ces N/a
Designed Primary Area 300 fe Diameter e- in
Designed Reserve Area 300 ft2 Spacing in
Trench/Bed Width 10 ft f Manifold
N/a
Trench/BedN�
Length 30 ft Sched C ��
nn
LFC E DESrC,NER.,' ft
Elevation Measurements Len p•r.:,— j ,
Original Drainfield Area Slope 1 % Diameter in
New Slope,If Altered 1 % Preferred manifold configuration used? 0 Yes P'No
Depth of Excavation up-slope 12 in Transport Pipe
from Original Grade Downslope 12 in Schedule/Class Sch 40
Designed Vertical Separation 36 in Length
68' ft
Gravelless Chambers Required? 0 Yes £No 0 Optional Diameter 1 1/2 in
Pump Required? '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 if'Higher El Lower thanPj,mp Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 15 gpm Lo1`fimer If lapse Meter ®'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. 22336530009a- — Q(uZq
Permit Number: SWG 2 0 22_- oD a c.(,
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
O Test hole locations V Drainfield orientation and layout Reference depth from original grade:
!� Soil logs 0 Trench/bed dimensions and RC Septic tank
0 Property lines critical distances within layout ®' Drainfield cover
0 Existing and proposed wells 0 D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 0 Septic tank/pump chamber and restrictive strata:
B Measurements to cuts,banks, and locations ifa Laterals,trench/bed,top and
surface water and critical areas B Observation port location bottom
0 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:
O Location and dimension of 0 Lateral placement with distance 0 Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
▪ Buildings Er Audible/visual alarm referenced Yes No
• Direction of slope indicator E( Scale of drawing shown on scale 0 V(Design staked out
0 Waterlines bar 0 0 Recorded Notices attached
O Roads,easements,driveways, 0 ❑Waiver(s)attached
parking ®' ❑ Pump curve attached
O North arrow and scale drawing Bey, . �a 0 ❑ Evaluation of failure
shown on scale bar
o�g ,Z Non-residential justification
"i Zm 0 0 Waste strength
LICENSED DF.SlGNER
0 0 Flow
DESIGN APPROVAL
The undersigned designer must be notifi y staller at time of installation 10 Yes ❑ No
/ ? 2
Sign esigner 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:
Qlwr\
-6\41
Environmental Heal Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
if The design is stamped "Approved"by Mason County Public Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: \7-- I Zc
O 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
�� 8 > m
Cl. 5E� wS•
.1 m a)
Ni
cr.
!✓ 9" w. .- a O RJ O
1-' �y��.��` �,c as,tt ate+ Q M N o
43li
o
pCU
'- ¢ rv) ¢ Q U _ m pers
cn
Barbara Blvd
I r-..
o0
°i 5 I' i Tv
t"rfl
►-
t I
li
- aI
Qa,
'-I
�,'
E
71- o NO FOUNDATION DRAIN
GRADIENT OF
PRIMARYO/ENSERVE DRAINFIELD
0
iN N s
m
9
n APPROVED2
° 0 7
MASON COUNTYAPR ENVIRONMENTAL2023 `�
HEALTH z
it
m
m RET
rn
-
C
0-
IA -Q 'D
CD
N f0
H
0
0--1 >. E
LC
E to
0
0 J
- 13C 0
0 c N C
m
, 1L. m M 00 4J
L LIY A
p ;� I- O I- f- O I-
it
I
1-1
ill J.' G1
Advantage Perc & Design
I4mely•ueasonabte•30 Years of L .,)cat Experience
Construction Notes fo.3. bedroom Gravity bed System
-Install 10'x 30' bed 12"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
A.
APPROVED
r 1
APR 0 7 2023 -ts
��,,
UCEr.` • i ;Nr.. •
•
MASON COUNTY ENVIRONMENTAL HEALT` E„�,,�s..,:.2
RET
Advantage Perc&design APDdesignsPicloud.com • (360) 516-7287
o
I I
NJ
0
c 6 < C _ m m Or\imi -0
ii
2, •:- 4-kgl'' tti, 1 a t rd 0) (JD L.n
Ln
APPROVEDin
APR 0 7 2023
MASON COUNTY ENVIRONMENTAL HEALTIZ
I— RET
cc
Z.
o Z
a)
I/ _
111
O ■-. am
' 0
ea o t
m
-NJ ' � v
ry i
m
Iitiotaillo---
a) S
m 'L an
.a
CD
Y
V
O
1_11-1
x
O
O
a 0
c
111
ea
Y 0
N '-
. ..
rip
AI
itliegRPturipss tr.---,, ,,,-;-,,,,„c
......_,,,
• j.
Pump Specifications . .;'. �• )
280 Series 1 /2 hp ,1,
Submersible Effluent Pump APPROVED
D
LITERS PER ISNUTE
0 50 100 150 200 250 APR 0 7 2023
40 — — 4 - ti • ' - - ' 1,q'SON COUNTY ENVIRONMENTAL HEALTH
RET
- 10
trri ►
1
1►
-- 8
i
f4
i
a
la
20 - , i - - e
I ,
0
10 , — ,
- 2
0 v • 0
0 10 20 30 40 50 80 70
GALLONS PER GIN NIE
280 P1 R01 W?I2Ois �pyrght 2015 Liberty Pumps Inc_ All rights Specifications ea 10 thaw wb1 L n tioe ,;'
I..,.UM M UP N SAS T1111R MEAL
1AOCIESS NM \
--... imiailf1111•111111110E
.110
/ "1
mit
IONS SE
mum FUMING MAT +-+.�..
- —' ! S14LI�ff
ilip
PLUM
1110111111101
F ....
_7 4........__..__....,it..L.,_....._
1 1 .
1200 gallon Intlarial
$ WIT.OASTISMrs U.
tHINIADIO UMW
MOM ROM ISM.
ar
'- i 1 �
:rat WPM . .,.._.
roM a
- -- - -- �n■MNar s1 SE . ANTS WHIM
11w1M1101�1.WaL
VIAL TMRO" 1Mi S
•
maws trauma" sainglimernear sue
POIRIPLOIX
NOUNTINS
smatamerurr ail
S SIAOYO' .11 ' CHOCK tlAl>M•
r,
ir
SYMfs ,'
•1- n I,I
1200 Gallon N
t,
mow env ,
ED
MASON COU TYR . 2023
Eh VIR7ONMEh TAB HEAITH
RET