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HomeMy WebLinkAboutSWG2023-00116 - SWG Application / Design - 3/28/2023 MASON Co U N TY 415 N 6TH STREET,SHELTON, ,E,E 400 98584 SHELTON: 42 T 967XT 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: SWG2023-00116 APPLICANT KEPNER JOSEPH R Phone: Address: 3724 REDWING TRAIL BREMERTON, WA 98312 OWNER KEPNER JOSEPH R Phone: Address: 3724 REDWING TRAIL BREMERTON, WA 98312 SEPTIC DESIGNER Richard Bazzell -Caliber Septic Design Phone: 360-509-7900 Address: 165 Tupleo Way POULSBO, WA 98370 Site Address: 201 NE Tahuya Valley Dr E Primary Parcel Number: 222067500180 Permit Description: 3-bedroom gravity system Permit Submitted Date: 03/28/2023 Permit Issued Date: 04/26/2023 Issued By: David Anderson Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system). Permit Expiration Date: 03/30/2026 (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 ONLY— C C MASON COUNTY DATE RECEIVED: �] ^ I �� I. COMMUNITY SERVICES AMOU RECEIVED: , // RECEIVED BY: nn ff v m Public Health(Community Health/Environmental Health) `ice—� C 415WItth6tr et•a0oay.WA ext.400 SWG /'� /-� �� - � O 1` I Z Cl) d75 N.6th Street•Shelton,WA 98564 _Ltd`'► l\) `/�'-�/ ON-SITE SEWAGE SYSTEM APPLICATION m n APPLICANT PHONE m r Joseph Kepner 218-251-107� Mn�Mq C MAILING ADDRESS-STREET.CITY.STATE,ZIP CODE I 3 PO BOX 1965, Belfair, WA 98528 r co c SITE ADDRESS-STREET,CITY.ZIP CODE MAR 2 8 2023 .c, Fi 201 NE Tahuya Valley Dr E, Tahuya, WA 98528 I N II NAME OF DESIGNER PHONE BY Caliber Septic Design - Richard Bazzell 360-509-7900 I N NAME OF INSTALLER PHONE 0 II To Be Determined n/a I a PERMIT TYPE(select one) DRINKING WATER SOURCE Lt I K RESIDENTIAL OSS I-J FCOMMUNITY OSSCOMMERCIAL OSS g PRIVATE INDIVIDUAL WELL ICE'PRIVATE TWO-PARTY WELL Z Iry(\ TYPE OF WORK(select one) PUBLIC WATER SYSTEM___ I 'I J NEW CONSTRUCTION/UPGRADES :REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑TABLE IX REPAIR v SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE co g DESIGN FORM(REQUIRED) Fj SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r I "\ 5 WAIVER(S)(IF APPLICABLE) 3 5.17 acres 0 I O DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) From WA-3 go north on Old Clifton Ln; turn right on Belfair Tahuya Rd for 1.2 miles; turn I p left onto Tahuya River Drive for 0.2 miles; turn right onto Tahuya Valley Dr E for 0.1 miles. r o I°� SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I G 1 --- OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) 0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER: INSPECTOR SOIL LOGS COMMENTS I CONDITIONS III: a-3z 4i fito frnc-I & cjl-32" TIZ: 0 -3q4.11 �S Tft3: 0 -31 (1Lf5 Tt1IL 0 -3141-Fs PeCtsii6PT qf` 3 l" ill SOIL CODES: RECORD DRAWING AND INSTALLATION REPORT V=VERY G=GRAVELLY S=SANG L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL. INS TO SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE . . /3t1/7oz3 3/5O/2076 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 ;3 i . DESIGN FORM—PAGE ONE Assessor's Parcel Number:2--Z-2--0 -- ? 3 0 O. ( 8.-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" $ilWil4-q-tWiA::::f‘Si•k*MICIVArt-ftnTi-eVAVVErtanaTtatiOlOrt440ftilF.Miii:-WMPVariragt:.04;1 ;-: Permit Number: SWG Designer's Name: Richard Bazzell Applicant's Name: Joseph Kepner Designer's Phone Number: 360-509-7900 Mailing Address: PO BOX 1965 Designer's Address: 165 NW Tupelo Way Belfair WA 98582 Poulsbo WA 98370 City State Zip City State Zip :.' -c,i5•M::ll.l?A:iVe'. :' t-"V*tllgt(W.gik'',$i'W•YipggitgitffaVXIVIETER:'SVWAE'tr 'gfrfit#MN;MS,VMf$Yt4r74P:'-''" Treatment Device 0 Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type: 0 Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: Drainfield Type IYGravity 0 Pressure 0 Treneli.,:•.. 0 Bed 0 Sub Surface Drip A •-e.A Septic Tank/Drainfield Specifications •-, •••••,.. Laterals . , . Number of Bedrooms 3 ..V,::-':. *tiedule/Class 40/3034 •Daily Flow:Operating Capacity 270 .0:117' . :Len • • 200 ft • . , .4• ' •--i N• Daily Flow:Design Flow 360 7gpd v Diameter 4 in Septic Tank Capacity(working) 1200 11394,t- gal 5. . NumbPA Receiving Soil Type(1-6) 4 % •:• ••c : ' : -. cp ,a,ifoill.: 5 on center ft Receiving Soil Appl.Rate 0.6,: - -grodif •• *, - -.-. Orifices Required Primary Area 600 ft2 Total Number of Orifices n/a Designed Primary Area 6 v 14"49° ft2 Vi Diameter n/a in Designed Reserve Area 1 141-0, 4 ft2 Spacing n/a in Trench/Bed Width 3 ft Manifold ... Trench/Bed Length 40 ft _ Schedule/Class D-Box Elevation Measurements Length n/a ft Original Drainfield Area Slope 3-5 % Diameter n/a in New Slope,If Altered Same % Preferred manifold configuration used? 0 Yes Ri'No Depth of Excavation Up-slope 7.5 - 12 in Transport Pipe from Original Grade Down-slope 6 in Schedule/Class 40/3034 Designed Vertical Separation 18 in Length 40 ft Gravelless Chambers Required? El Yes 0 No NrOptional Diameter 4 in Pump Required? 0 Yes E'No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day n/a Diff.in Elevation Between Pump&Uppermost Orifice n/a ft Dose quantity n/a gal Drainfield Squirt Height/Selected Residual(head) n/a ft Chamber Capacity(flood) n/a gal Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump LoArppRhatimetd_ Capacity @ Total Pressure Head n/a gPm r 0 Event Counter Calculated Total Pressure Head n/a ft If Timer: Pump on n/a ,Pump off n/a APR 2 6 2023 Comments . MASON COUNTY ENVIRONMENTAL HEALTP D J A ........m.....=••• ppn.. if DESIGN FORM—PAGE TWO Assessor's Parcel Number:____ -- 7 Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch P1 Test hole locations 0 Drainfield orientation and layout Reference depth from original grade: El Soil logs Lot Trench/bed dimensions and Ef Septic tank El Property lines critical distances within layout 0 Drainfield cover El Existing and proposed wells g D-Box/Valve box locations Reference depth from original grade within 100 ft of property Lot Septic tank/pump chamber and restrictive strata: O Measurements to cuts,banks,and locations H Laterals,trench/bed,top and surface water and critical areas Ef Observation port location bottom O 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: O Location and dimension of 0 Lateral placement with distance El Observation ports/clean-outs primary system and reserve area to edge of bed ,; Other Information El Buildings 0 Audible/visual a .�"ti •ferenced Yes No El Direction of slope indicator I. Lot Scale of drawi ••o ,)on scale 0 g Design staked out RI Waterlines bar ; '' • II 0 Eg Recorded Notices attached Roads,easements,driveways, Ef Roads, Ef 0 Waiver(s)attached parking 0 '� Mt.ir y�.1 0 l Pump curve attached i :.3 o d, El Evaluation of failure El North arrow and scale drawing � :�i' � _ <�i+ shown on scale bar . f`+ Non-residential justification 21037126•• t'tI ❑ ❑ Waste strength t RICHARDircWSFD L gDf AllELLSIGNER 0 0 Flow V 1;M.s to,,• 0.1L, r, �'�. '•`•.'°R1 The undersigned designer must be notified by installer t ti of• stallation Ig Yes ❑ No 3/4/26 2-$ Sign tune of Designer Date The undersigned has reviewed this design on behalf of Mason CountyPublic Health Ai etermined it to be in 7 compliance with state and local o gulations: r R® °� q >,,,i ,//Aior /( 6(zoz3 'vironmental Health Specialist Date APR 2 6 2023 CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FoLOWENditittitAttiONNTAL'nc.ALT ✓ The design is stamped"Approved"by Mason County Public Health. DJA ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: ✓ 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 CO CO �) Q) CT A CO ND C) CT .a w N O m a a -iN D DOmDc � 0 g -i * ma � ccn —1 - � > % a o v � 5' D m 0 CO O CD 0 S cU C O CD CD -0O r a a) S O S °� 0 u0i (D a C co - (SD (D `�' n V1 _ (D a7 U1 a X CD 0 C a - �' m c _•a C)-o �+ m o m ur a - 0 cu .� <n n) m m a) cD D - 0 v (D (0D a) CD N 7' `—' d 3 3 G7 �. FP- C0D a CCDD CDO cD N `7 (D O 0 CDO O CDO CD CD 0 T) N -0 p). CD O r 0 d ='< O 'o a a ?. (D co a * d a) * o co o. N co cD cD O 3: = O- cR. O' S C. cn 0 C7 CD c0 �. 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