Loading...
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 `� N 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+ Z 6 ON-SITE SEWAGE TANK ONLY APPLICATION Z m n 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 RET p3 W C.• V V � �^ Q 6 3-- 3s � 1 4 o S -��- o -� 0 ♦y y �7 A mil\ s P C131 q , a v. I At-herjd . . (---/----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 �I inboard lifting lugs allow for easy fr' ,. delivery and handling /; / �; l f �! �/ (il f 1)� a i 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 r 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 i „�i• o I o � �„� Dssot to deliver proven means of maintaining a watertight seal. ;,�1 .� I. ` E�TM `��►,u E■ 6.. to�hc,+' 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 S I I 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) 010 ` I Ia X56t rn0191 IL Inoh'lG e6‘ covvrcd fatzi n � ,lr, Driveway 14 q01 • _ - - — - -5E i-IAC,l1IG4 ANA, _ _ _