HomeMy WebLinkAboutSWG2023-00124 - SWG Application / Design - 4/3/2023 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 Tank Only Permit: SWG2023-00124
OWNER BREITBACH RON Phone:
Address: 802 S 1ST ST PORT ANGELES, WA 98363
APPLICANT BREITBACH RON Phone:
Address: 802 S 1ST ST PORT ANGELES, WA 98363
SEPTIC INSTALLER Shane Maples- MAPLES EXCAVATING Phone: 360-463-8474
Address: 911 SE Arcadia Road SHELTON, WA 98584
Site Address: 201 SE FUCHSIA AVE
Primary Parcel Number: 319045400042
Permit Description: Replace septic tank
Permit Submitted Date: 04/03/2023
Permit Issued Date: 04/03/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 04/03/2024 (based on date of inspection)
Type of Work OSS Repair
Components being Replaced: Septic Tank Only
Surfacing Sewage? No Existing Failure? Yes
Shoreline? No Horizontal Setbacks Met? Yes
Number of Bedrooms: 2 Drinking Water Source: Public Water System
Additional Details: IM-1060
Permit Conditions:
4 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.
1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is
obtained
3 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/OR 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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
DATE RECEIVED 4 2
-45
MASON COUNTY 7 `�
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JI- •� COMMUNITY SERVICES il. AMR • RECEIVECO Cnv �
Public Health(Community Health/Environmental Health) a C N
415 N.6th 70.Street•4ee It n.WA 8584 ext.4e0 S W G �O ♦ y — _Y 0-4 N T
416 N.bth Street-Shelton.WA 98584 L7 a—�v' It+
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ON-SITE SEWAGE TANK ONLY APPLICATION Z
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APPLICANT PHONE r
Ron Breitbach 360-809-0331 Z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE
802 S i St. Port Angeles, WA 98363 '5 z
SITE ADDRESS-STREET,CITY,ZIP CODE ``
201 SE Fuchsia Ave. Shelton, WA 98584 9 6`-'
NAME OF DESIGNER PHONE I
n/a
NAME OF INSTALLER PHONE
v
Maples Excavating 360-463-8474 <
TYPE OF WORK(select one) DRINKING WATER SOURCE N
❑ NEW CONSTRUCTION!UPGRADES MI REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 0 PRIVATE TWO-PARTY WELL Z
COMPONENT(S)TO BE REPLACED/INSTALLED CI PUBLIC WATER SYSTEM 1
0 SEPTIC TANK 0 PUMP TANK 0 RV HOLDING TANK BEDROOMS LOT SIZE Ivi
❑ OTHER 2 0.25 c
OTHER DETAILS(select all that apply) TANKS)SETBACK CHECKLIST r
O I
CISURFACING SEWAGE lieEXISTING FAILURE ElSHORELINE 4 100FT+PUBLIC/COMMUNITY WELLS n
SUBMITTALS • SOFT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS
pi PLOT PLAN(REQUIRED) El TANK CROSS SECTION(REQUIRED) 0!OFT+DRINKING WATER SUPPLY LINES
❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) ❑ 5FT+PROPERTY/EASEMENT LINES,FOUNDATIONS,FOOTINGS
PLOT PLAN CHECKLIST r 0
❑ PROPERTY LINES AND EASEMENTS 0 EXISTING/PROPOSED STRUCTURES 0 EXISTING/PROPOSED OSS COMPONENTS AND LINES --/
❑ WELLS WITHIN 100FT 0 WATER SUPPLY LINES 0 DRIVEWAYS/PARKING 0 SURFACE WATERS,STREAMS,RIVERS,ETC...
❑ DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS ❑ NORTH ARROW 0 SCALE BAR ul
DIRECTIONS TO SITE AND SITE CONDITIONS-(ex locked gate) ri
Abaroor' no koAed knv7 .t \S hog waq u\' 6eNr hovee .
mb\r i no, ou-k i6t ac-' n(5v5t in-\o vo,Yc . IhS\all t'nc)
10(00 inciI kYONOY Sevkic iam
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 14MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER: B 1 \'1l 1!,
COMMENTS/CONDITIONS
APR- APR 0 3 2023 J
( Shavq.I- i3h3 t - Gt -. Ts ik5d.t i t 4 . _.�
SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS". TANKS MUST MEET CUR MINIMUM SIZE REQUIREMENTS,EQUIPPED WITH—RISERS
AND LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
(A. L' I (413/7S
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12n12015
APPROVED
APR 0 3 2023
MASON COUNTY ENVIRONMENTAL HEALTH
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(---/----uN FI LTRATOR® IM-1060
septic tanks APPRO
2023 Factures&Benefits
ASON COUNTYENI�RONMENTq� Strong injection molded polypropylene
RET iowuction
l • Lightweight plastic construction and
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inboard lifting lugs allow for easy
fr' ,. delivery and handling
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Integral heavy-duty green lids that
' interconnect with TWTM risers and pipe
I • ) riser solutions
Kre Eat r rut tr[i[tt It i( KK Illt IN ( tildill 11111 N a r; • Structurally reinforced access ports
eliminate distortion during installation
and pump-outs
r . . it, y , • Reinforced structural ribbing and
fiberglass bulkheads offer additional
,, strength
• Can be installed with 6" to 48"
of cover
The Infiltrator IM-1060 is a lightweight strong and durable septic tank. • Can be pumped dry during
This watertight tank design is offered with Infiltrator's line of custom-fit pump-outs
risers and heavy-duty lids. Infiltrator injection molded tanks provide a • Suitable for use as a septic tank, pump
revolutionary improvement in plastic septic tank design, offering long-term tank, or rainwater(non-potable)tank
exceptional strength and watertightness. • No special water filling requirements
Inlet Side are necessary
pj • The tank may be backfilled with suitable
TANK CUTAWAY Infiltrator native soil.See installation instructions
TW Riser ,+ for guidance.
System- •
Partition •
baffle wal`.. •
HEAVY DUTY LID
CUTAWAY
`ti Reinforced•
24" structural
access port
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x. \ Structural
1 9' ----- �—'bulkheads
I . MID-SEAM CUTAWAY
Reinforced water tight mid-seam
7.-' gasketed connection
.re4 ,
INFILTRATOR`'
Protecting the Environment with Innovative Wastewater Treatment Solutions water technologies
IM-1060 General Specifications and Illustrations
,_,,,TING STRAP LIFTING LUG RISE CONNECTION
(TYPICAL) �(4 TOTAL) (TYPICAL)R
The IM-1060 is an injection molded two piece mid-seam \\ Ir" fr�'�a!-�•�+?'lW��'rriii-N,
Al � 1 Irl I_�
plastic tank. The IM-1060 injection molded plastic design �,. ��_
allows for a mid-seam joint that hasprecise dimensions A ��'�'" �.,a.',
'il!�► 'sl I I 1 1 •' f , �: 1
for accepting an engineered EPDM gasket. Infiltrators , o , o —.,, B
gasket design utilizes technology from the water industry ._. .�_II °o b I i °o—011-s 62.2
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to deliver proven means of maintaining a watertight seal. ;,�1 .� I.
` E�TM
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The two-piece design is permanently fastened using a *' i j *'
series of non-corrosive plastic alignment dowels and IP 1111( J ^ -'
locking seam clips. The IM-1060 is assembled and sold `�`+�~� �'� " ���
through a network of certified Infiltrator distributors. 127.0(3226)EXTERIOR LENGTH
IMust be backfilled and installed in accordance with TOP VIEW
Infiltrator Water Technologies, Infiltrator IM-Series Septic ouTLET
Tank General Installation Instructions and for shallow
il ground water conditions reference the Infiltrator IM- int
Series Tank Buoyancy Control Guidance. III 54.7
Please visit www.infiltratorwater.com/images/pdf/ 6= == 13891
q EXTERIOR
ManualsGuides/TANK01.pdf for the latest information- lAW'
HHEIGHT
SEAM CLIP
p �.n (TYPICAL)IM-1060LIFTING STRAP
Working Capacity 1094 gal(4141 L) (TYPICAL)
Total Capacity 1287 gal(4872 L) END VIEW
Airspace 16.5%
Length 127"(3226 mm) 04(102) 0 24(610)ACCESS OPENINGS WITH LOCKING LIDS(2)
PVC OR ABS 0 4(1021 PVC OR
INLET TEE 10.2 l2601 FREEBOARD
Width 62.2"(1580 mm) ABS OUTLET TEE
Length-to-Width Ratio 2.3 to 1 � ��
�—.al:►ixva iii OUTLET
Height 54.7"(1389 mm) PER
);6) 1 PER
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Liquid Level 44"(1118 mm) 440 —
FIBERGLASS (1118) FIBERGLASS
Invert Drop 3"(76 mm) SUPPORT LIQUID SUPPORT
(TYPICAL) DEPTH (TYPICAL)
WITH BAFFLE
Fiberglass Supports 2 WALL WHERE )
REQUIRED
Compartments 1 or 2
Maximum Burial Depth 48"(1219 mm) SIDE VIEW
Minimum Burial Depth 6"(152 mm)
i
Maximum Pipe Diameter 6"(152 mm)
TANK TOP CONTINUOUS
Weight 320 lbs(145 k ED HALF � /,�GASKET
i s P Rw TANK W
APR 3 2023
INTERIOR SEAM CLIP
ENVIRONMENTA1-N1iLIGNMENT
MASON coUNn DOWEL \ TANK BOTTOM
to---
4 Business Park Road RED i HALF
P.O.Box 768
CT 06475
Old
Saybrook,
N F I LT R AT O Rr 860-577-7000•Fax 860-577-7001 MID-HEIGHT SEAM SECTION
1-800-221-4436
water technologies www.infittratorswater.com
U.S.Patents:4,759,661;5,017,041;5.156,488;5,336,017;5,401,116;5,401,459:5,511,903;5,716,163;5,588,778;5,839,844 Canadian Patents:1,329,959:2,004,564 Other patents pending.Infiltrator,Equalizer,
Quick4,and Sidewinder are registered trademarks of Infiltrator Water Technologies.Infiltrator is a registered trademark in France.Infiltrator Water Technologies is a registered trademark in Mexico.
Contour,MicroLoaching,PolyTuff,Chamborspaoer,Mult(Port,PoaiLock,C1u{ckCut,OuickPlay,SnapLock and Straigh(Lock are trademarks of Infiltrator Water Technologec.
PolyLok is a trademark of PolyLok,Inc.TUF-TITE is a registered trademark of TUF-TI'E,INC.Ultra-Rib is a trademark of IPEX Inc.
e 2016 Infiltrator Water Technologies,LLC.All rights reserved.Printed in U.S.A. IM02 1116
Contact Infiltrator Water Technologies' Technical Services Department for assistance at 1-800-221-4436
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/ PERMIT INFORMATION
Permit Number SWG)0?,2)-00I a'-} Parcel #1,Ig04-5q-00Q'->F3-
Applicant Name Ron P)rel}106kC.h Subdivision (Name/Div/Block/Lot)
Applicant Address A82 G.l5-{- $-l-. t j3f Lie
City, State, Zip port fl(lr(tsi WA clg3t3 Installer Name MOPICS Excava-hrl
Site Address xi a PLAchsia Ave Designer Name
INSTALLATION CHECKLIST
❑ Full System Installation Ilank(s)Only ❑ Drainfield Only ❑ Repair ❑ Other
System Type GI CO UlN Pretreatment Type
>5 ft.from foundation? - - ❑ N/A BYES ❑ NO
>50 ft.from wells? ❑ sr ❑
Z >50 ft.from surface water? I tom- - -� - ❑ R" ❑
H Cleanout between building and tank? - - - - ft--- a $ 271Z3 ' ❑ LN ❑
V Tank baffles present? - lid 0 Q" ❑
a24"access risers over each compartment?- - ID [2/ El
W Effluent filter installed?- By---- - ❑ Edt/ ❑
cn
Septic tank capacity(working) 10(_Q0 gal Manufacturer I ff r (
1 0 D-box water level and speed levelers used? - - ❑ NIA ❑ YES ❑ NO
oO Manifold/D-box accessible from surface?- - ❑ CI CI
m Z Check valves installed? - - ❑ ❑ ❑
ciQ
2 Transport Line Size Schedule/Class
Bedrooms installed (check one) d2 0 3 ❑4 El 5 El 6 El Commercial/Other
>10 ft.from foundation? - - ❑ N/A ❑ YES ❑ NO
>100 ft.from wells?- - ❑ ❑ ❑
WCI CI>100 ft.from surface water? - - ❑
u. >10 ft.from potable water lines?- - ❑ ❑ ❑
Z > 5 ft. from property lines and easements?- - ❑ ❑ El
Q
cc > 30 ft.from downgradient curtain/foundation drains? - - ❑ ❑ ❑
o
Drainfield level and observation ports present - - ❑ ❑ ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over drainfield?- - ❑ ❑ ❑
Pump tank setbacks consistent with septic tank? - - ❑ N/A ❑ YES ❑ NO
Pump tank capacity (flood) I Manufacturer
Q24" access riser(s) and accessible from su ce?- - ❑ ❑ ❑
F-
a Alarm or Control Panel Installed? - - CI CI CI
2 Control Panel equipped with Timer/ETM/Co n r- - ❑ ❑ ❑
n
a_ Pump installed in ❑ Bucket or ❑ On lock El Other
a Pump Make/Model 0 Floats or El Transducer
a.
a Tank draw down in/min Pump capacity gpm Squirt Height ft
Pump on time Pump off time Daily flow set at gpd
Updated 8/21/2018
Mason County OSS Installation Report pg. 2 Parcel# 1)I°IO 4 "S4 J 00042-
ABANDONMENT RECORD
Were existing septic components abandoned as part of this project? - - [.i YES EI NO
If yes, please describe:
Were all components pumped out and properly abandoned per WAC246-272A-0300? - - d YES ❑ NO
RECORD DRAWING
This is a permanent record and must be accurate and descriptive enough to re-locate in the need of maintenance activities and future development. Typical Record
Drawings contain, Drainfield&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings,location of wells,waterlines,
i wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits.
dRecord Drawing Attached
CERTIFICATION OF INSTALLATION
INSTALLER DESIGNER/ENGINEER
I certify that I installed the system in accordance with I certify that the system has been installed in accor-
the septic design stamped"APPROVED"by Mason dance with the septic design stamped`APPROVED"by
County Public Health and that any deviations shown Mason County Public Health and that any deviations
here have been cleared/approved by both the designer shown here have been cleared/approved by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
and Mason County Codes. State and Mason County Codes
I further certify that all information contained on this I further certify that all information contained on this
form and attached Record Drawing is accurate. form and attached Record Drawing is accurate.
�4,.. /11,_ L4 121123
Signature of Installer Date
crane Ma,pt c
Printed Name of Signee
MASON COUNTY PUBLIC HEALTH
The undersigned approves this Installation Report and
Record Drawing on behalf of Mason County Public
Health: �M I2 1
\( A1\01-Y
Signature of Environmental Healt Specialist Date (stamp, signature and date)
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE Updated 8'21,2018
RECORD DRAWING (continued)
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