HomeMy WebLinkAboutSWG2023-00065 - SWG Application / Design - 3/2/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
I, 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: SWG2023-00065
APPLICANT WOLF BRANDON & SAREANA Phone: 360.463.7080
Address: P 0 BOX 1032 SHELTON, WA 98584
OWNER WOLF BRANDON & SAREANA Phone: 360.463.7080
Address: P 0 BOX 1032 SHELTON, WA 98584
SEPTIC DESIGNER ROD LEFT-Acme Design Phone: 360-509-2000
Address: PO Box 2954 SILVERDALE, WA 98383
Site Address: UNKNOWN
Primary Parcel Number: 321262394002
Permit Description: New SFR -3BR Gravity w/class b waiver
Permit Submitted Date: 03/02/2023
Permit Issued Date: 04/18/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $685.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 03/08/2026 (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.gov/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
•
OFFICIAL USE ONLYS C ' `.,
DATE RECEIVED: 3 _ a - 123
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ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT 'PHONE r
Brandon Wolf 1 360-463-7080 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE g
P. O. Box 1032 Shelton WA 98584 co
SITE ADDRESS-STREET,CITY,ZIP CODE
E. Mason Lake Rd Shelton WA 98584 I CA'
NAME OF DESIGNER PHONE N
Rod Left 360-698-8488
NAME OF INSTALLER PHONE 0
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DRINKING WATER SOURCE - IV
PERMITpp'';; TYPE(select one) GG �^�--�I` ��, C)
WIRESIDENTIAL OSS COMMUNITY OSS ILJ,COMMERCIAL OSS 51 PRIVATE INDIVIDUAL WELL I70!PRIVATE TWO-PARTY WELL Z
TYPEPEp OF WORK(sated oneJ al PUBLIC WATER SYSTEM ,
Fit NEW CONSTRUCTION I UPGRADES 51 /REPLACEMENT OTHER DETAILS(select all Mel apply) 0 TABLE IX REPAIR N
SUBMITTALS � El SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
ITDESIGN FORM(REQUIRED) PT SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE W Co
ZWAIVER(S)(IF APPLICABLE)
6 654,706 0 I
x I CD
DIRECTIONS TO SITE AND SITE CONDITIONS:(en.locked gale)
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SITE SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. N
OFFICIAL USE ONLY BELOW THIS LINE— —
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ❑COMPLAINT 0 OTHER:
INSPECTOR SOIL LOGS t1 COMMENTS/CONDITIONS
1, L1 IS( �5 Dili „ dC
3
3- (s.,„
MAR 02 2023
'1) , ---) 11-4,1)-padii At;
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.
INSP R SIGNATURE DATE APPLICATION EXPIRATION DATE APPLIOAT N PP OVED/ISSUED BY DATE
1 4 VAA.K36 -; 3 -5— - .2_ U r
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THIS OHM Mtn BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
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DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 1 2 6 — 2 3 — 9 4 0 0 2
' 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. 0 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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Permit Number: SWG 1_6,-3- (S Designer's Name: Rod Left
Applicant's Name:
Brandon Wolf Desi er's Phone Number: 360-698-8488
Mailing Address: P.O.Box 1032 Designer's Address: P.O.Box 2954
Shelton WA 98584 Silverdale WA 98383
City State Zip
iPx i City State Zip
��Mf .•r�� Y. 4F;:'0 -i- i4L i E'�'K A ' TERO v4W q5likt.F YVaRA h .X1W siT Treatment Device
❑Glendon Biofilter ❑Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
Bf Gravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 6 Schedule/Class 40
Daily Flow:Operating Capacity 1320 gpd Length 80 ft
Daily Flow:Design Flow 680 gpd Diameter 4 in
Septic Tank Capacity 2000 gal Number 5
Receiving Soil Type(1-6) 4 Separation 5 ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 1200 ft2 Total Number of Orifices NA
Designed Primary Area 1200 ft2 Diameter NA in
Designed Reserve Area 1200 ft2 Spacing NA in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 400 ft Schedule/Class NA
Elevation Measurements Length NA ft
Original Drainfield Area Slope 3-8 % Diameter NA in
New Slope,If Altered 3-8 % Preferred manifold configuration used? 0 Yes ❑No
Depth of Excavation Up-slope 13 in Transport Pipe
from Original Grade Down-slope 9 in Schedule/Class 40
Designed Vertical Separation 18 in Length 50 ft
Gravelless Chambers Required? 0 Yes 0 No lif Optional Diameter 4 in
Pump Required? 0 Yes 1I No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day NA
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity NA gal
Orifice ft Chamber Capacity NA 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
Class B Waiver
r
DESIGN FORM—PAGE TWO Assessor's Parcel Number:3 2 1 2 6 — 2 3 — 9 4 0 0 2
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
EA Test hole locations 121 Drainfield orientation and layout Reference depth from original grade:
0 Soil logs lif Trench/bed dimensions and lif Septic tank
FA Property lines critical distances within layout Drainfield cover
RI Existing and proposed wells 66 D-Box/Valve box locations Reference depth from original grade
within 100 ft of property Bi Septic tank/pump chamber and restrictive strata:
121 Measurements to cuts,banks,and locations Iif Laterals,trench/bed,top and
surface water and critical areas WI Observation port location bottom
0 Location and orientation of Eg 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:
FZ1 Location and dimension of Ili Lateral placement with distance GA Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
EZI Buildings 0 Audible/visual alarm referenced Yes No
6I Direction of slope indicator RI Scale of drawing shown on scale 0 fR'Design staked out
1 Waterlines bar 0 g Recorded Notices attached
FE Roads,easements,driveways, Eil 0 Waiver(s)attached
parking 0 12(Pump curve attached
1 North arrow and scale drawing 0 RI Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑Flow
• DESIGN APPROVAL
The undersigned designer must be notified by inst er at t. ins anon lif Yes 0 No
l z 4Pr1 r zvz3
Signs 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 on- ' egu ations: I
lei
,,,,,,,
En - . Health SpecidIi t 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: 3,15-..)-/(Q
✓ 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
Mason County WA GIS Web Map
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