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HomeMy WebLinkAboutSWG2023-00105 - SWG Application / Design - 3/20/2023 ri .„ ON, 584 MASON COUNTY 415 N 6TH STREET,SHELT967 ,E 98400 SHELTON:360 427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 • v'' Public Health & Human Services ELMA:360-482-5269,EXT 400 ,,.... FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2023-00105 OWNER GRAY CHERIE Phone: Address: 33 E SEASHORE LN SEQUIM, WA 98382 APPLICANT GRAY CHERIE Phone: Address: 33 E SEASHORE LN SEQUIM, WA 98382 SEPTIC INSTALLER DARIN OGG- Royal Flush Septic Phone: 360-790-3021 Address: PO BOX 1336 HOODSPORT, WA 98548 Site Address: 295 N WEBSTER LN Primary Parcel Number: 224065100907 Permit Description: Septic tank replacement Permit Submitted Date: 03/20/2023 il Permit Issued Date: 03/24/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 03/24/2024 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Septic Tank Only Surfacing Sewage? No Existing Failure? Yes Shoreline? Yes Horizontal Setbacks Met? Yes Number of Bedrooms: 2 Drinking Water Source: Private Two-Party Well Additional Details: Hagerman 1250 ST Permit Conditions: 3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 2 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 4 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 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/onsiteloss-inspection-request.php or call: 360-427-9670, extension 400. ,.' la OFFICIAL USE ONLY DATE RECEIVED:MASON COUNTY • 1Q' 1 co x. COMMUNITY SERVICES r 1 • ., a or •� o� co m Public Health(Community Health/Environmental Health) `� 1 C 360,i79670.oR,00a36tr27S446t.aa.l00 SWG �1'Z►� - o 0 Ai 5 N 6th Sheet-Shelton.WA 96584 z ui ON-SITE SEWAGE TANK ONLY APPLICATION z > APPLICANT PHONE m m Lv\c\ \2 Gv \ 5(Q O `k kQ b-- -3 L \ Z MAI EIG ADDRESS-STREET•CITY,STATE,ZIP CODE C CO Ica `\C3 ) 3 SuaS�o�re_ un SevL\ lam CO SITE ADDRESS-STREET,CITY,ZIP CODE73 D‘C15 N Wz.\CIS -kr L>n L\1I \W(K V4) S5c� I9J NAME OF DESIGNER PHONE I NAME OF INSTALLER I- DA yin o 9 Gr-; qv.s0 ) j PHc' 3L2u) Sao -50zI 0 o TYPE OF WORK(select one) DRINKING WATER SOURCE a 0 NEW CONSTRUCTION/UPGRADES *REPAIR/REPLACEMENT 0 PRIVATE INDIVIDUAL WELL 4(PRIVATE TWO-PARTY WELL Z lc COMPONENT(S)TO BE REPLACED/INSTALLED D PUBLIC WATER SYSTEM SEPTIC TANK 0 PUMP TANK CI RV HOLDING TANK BEDROOMS LOT SIZE I r 0 OTHER 1�?� NA\�—` I��1 0 IJ OTHER DETAILS(select all that apply) TANK(S)SETBACK CHECKLIST 1" ❑ SURFACING SEWAGE WXISTING FAILURE ❑SHORELINE 100FT+PUBLIC!COMMUNITY WELLS 0 (r SUBMITTALS 50FT+PRIVATE WELLS,SURFACE WATERS,STREAMS,RIVERS I V' LOT PLAN(REQUIRED) TANK CROSS SECTION(REQUIRED) ('10FT+DRINKING WATER SUPPLY LINES ( I(� ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPUCABLE) �+PROPERTY/EASEMENT LINES.FOUNDATIONS,FOOTINGS \"' PLOT PLAN CHECKLIST 0 I !� O !PROPERTY LINES AND EASEMENTS C IST)NG/PROPOSED STRUCTURES :$-EXISTING/PROPOSED OSS COMPONENTS AND LINES -i tiLWELLS WITHIN 100FT ( WATER SUPPLY LINES DRIVEWAYS/PARKING g[SURFACE WATERS,STREAMS,RIVERS,ETC... j I C' IRECTION OF SLOPE/CONTOURS Q EL NORTH CURTAIN DRAINS NORTH ARROW 12 S(:ALE BAR (l(J�- DIRECTIONS TO SITE AND SITE CONDITIONS:(er.locked gate) �1 ( � VC)\\ �C CACk L v� o' `A 1�J1 e6 -- —OFFICIAL USE ONLY BELOW THIS LINE UPGRADE,FAILURE SOURCE(for waling purposes) O VOLUNTARY ❑MAINTENANCE/PUMPING El BUILDING PERMIT ❑HOME SALE OCOMPLAINT 0•a ^ rp n �� r COMMENTS/CONDMON5I) Mi L c245\ Ln 1� ' MAR 2 0 2023 Vit J SEWAGE TANKS MUST BE LISTED UNDER DOH'LIST OF REGISTERED SEWAGE TANKS-. TANKS MUST MEET CURRENT MINIMUM,.�••^.,r +o. i „^ i,; TS,EQUIPPEDW(1R-I21SERg AM)LIDS TO SURFACE,AND INCLUDE AN EFFLUENT FILTER(IF APPLICABLE). RECORD DRAWING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL INSPECTOR SIGNATURE DATE APPLICATOR EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE ' /--1 Ll (7;3 :VT\k04 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE 1V_ REVISED 12lT2O15 LLJ \ AM UllIb.IlId,UIII:UUIIIyWd.yUv ■ V LJ T OO • TerraScan T... VI 224065100... 1I SWG As-Bui... 0 Design-N... ekengineeri... xo2 -... 1 ♦ J / U N__J —\ , V f I l VV I U II I ., N/--Lr •rc.Y 1JIun r «n. • i • $9 I . . 1 . ri--:- -- . kI • • I I ' I I r \ \ ! • 1iti . , , 1 . . , ,.. , 1/414') 4. _.... I. --4.1 • 41" I •[—I.. 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Mason County Search in document CQ Mason > ... > 2 > 24 > 06 > 224065100907 > SWG As-Built - 8/19/1981 LI T 4' 1 / 1 k 0 0 Fit width c Q $ View plain text . ch"Elb_4,�dor Gt sbc1�. /A uQ4,tflake�s-A,LtLk M . $sts THIS RECORD IS NOT A GUARANTEE OF P6�. LEGAL .� (`- t A SEPTIC SYSTEM IS NOT A MUNICIPAL SEWER. HOWEVER OESCRNRKON kit I S E.-'l'IPthin t1�i WITH PROPER MAINTENANCE AND CAREFUL USE OF WATER IT CAN GIVE MANY YEARS OF TROUBLE FREE SER- , VICE. MANY PROBLEMS WITH SEPTIC TANKS ARE CAUSED SOIL BY FLUSHING EXCESSIVE AMOUNTS OF PAPER. CLOTH OO44A4B4TS ao4...11 tfAfAlasft. ialitL 31..ak t.k.. AND PLASTIC MATERIALS DOWN THE DRAIN. OR BY SITE FIELD LARGE AMOUNTS OF WATER FROM LEAKY FAUCETS OR NO. 1.22 5 9 SIZE to X jr FAULTY FIXTURES. DEPTH TO P MONTH THE SEPTIC TANK ITSELF SHOULD BE CLEANED EVERY WATER TABLE OF YEAR V • TWO OR THREE YEARS DEPENDING ON THE HABITS OF THE iNST e'er FAMILY, THE NUMBER Of FIXTURES IN THE HOUSE, AND AUfas Iti aac_ a . 1r tE t Ct. , THE AMOUNT THAT A GARBAGE DISPOSAL IS USED.CLEW. SIZE ING AT THE RIGHT TIME WILL AVOID THE RISK OF INJUR- SEPTIC TANK(S) 1 soot_ ING OR DESTROYING THE DRAMFIELD DUE TO SOLIDS anIINGTH FEET CARRYING OVER INTO THE DRAINFIELD. CALL THE MASON COUNTY HEALTH DEPARTMENT FOR A LIST OF TRENCH AREA $a. t t,OSQ. FT. LICENSED SEPTIC TANK CLEANERS IN YOUR AREA. THE 1 CLEANER CAN SERVE YOU BEST If YOU SHOW HIM THIS Tat Dam AtteW.B CORRUGATED 0 RIGID ❑ CEMENT RECORD WHEN HE COMES. _ OWN HEAVY TRUOCS OR EQUIPMENT SHOULD NEVER BE CU. ros. /3 `"Mer Me a.-to el"DEPTH DRIVEN OVER THE TANK OR ORARNRELD. CONSULT THIS SPIN RESERVED FOR RECORD IN CASE OF ANY BUILDINGS. DRIVEWAYS, mAameNTDGTRIBUT10N FIELD: SQ. FT. SWIANMING POOLS, OR EXTENSIVE GRADING OR RUING ARE LATER CONTEMPLATED. + NORTH • SHRUBS OR TREES SHOULD NOT BE PLANTED CLOSE TO ` THE SEPTIC TANK AS THEY WOULD INTERFERE WITH Oak �. CLEANING OF THE TANK. THEY CAN BE PLANTED IN THE DRAINFELD AREA PROVIDING WILLOWS ARE NOT USED. THE YARD GRADE IN THE DISPOSAL AREA SHOULD BE /E{ • SUCH THAT SURFACE WATER IS NOT POCKETED ON THE �t/' DRAINFIELb. ANY SETTLING OF THE GROUND OVER THE TRENCHES SHOULD BE FILLED IN WITH SOIL. DO NOT EX- CESSIVELY WATER THE LAWN IN THE DRAMiIELD AREA , WATER EVAPORATION FROM THE DRAINFIELD IS ABOUT 01 EQUAL TO ONE HALF IN OF RAIN PER DAY. FOOTING DRAINAGE, DOWNSPOUTS AND WATER A P p SOFTENER RECHARGE WATER SHOULD NOT BE CON— NECTED TO THE SEPTIC SYSTEM OR DISCHARGED INTO THE r VED AREA. MASON��+ M R 2 THE TYPES OF BACTERIA NEEDED IN A SEPTIC TANK ARE UN ENVIRONM ALWAYS FOUND IN SEWAGE. THERE IS NO NEW TO ADO EN HEALTH YEAST OR OTHER STARTERS TO A SYSTEM. THE USE OF RE- RET JUVENMTORS OR CHEMICALS TO CLEAN A SEPTIC TANK HAVE NOT BEEN PROVEN TO BE BENEFICIAL AND MAY BE HARMFUL BY RUSHING SOLIDS OUT OF THE TANK OR BY -. ,, CHANGING THE CHARACTERISTICS OF THE SOIL THE NORMAL USE OF BOWL CLEANERS OR CLEANING 00111- POUNDS WILL NOT KILL THE BACTERIAL ACTION OR SLOW scum + DOWN THE OPERATION OF THE SEPTIC TANK. I • / ii sc 1 W R a R y:i.) ,a U L1 trl b. rc— � y x 1 • f 3 p e Rzees : 1 o a a � ° a Z e '�G i i I 0 W N "S! : g X i e i i .VII . .tV W X e : ia^ #....1" C o .A i i i.K..F....{. i .¢. .a---4. ' '" 1 1 P %I i F s I C t n t X X X X . A a . e t a t ; of sr A r....4 *. n t / u , X X ■ A X . II X . sY i s .s,. X • 1 . , A/� A I '/ X M 1 n • I 1 n X . , 1 X • , 11 i Y i � *v.zv*vssa�a 4111� .Fary .fa 1 Y = X X 1 MgSoNC MqR 2 e0 mi 6 a f• 3 ^ '3 4 A .: ,t. 7.' '7.,-, ',-54 i G � g �r £ 8: - 1 °; p1 �Zi� �=�.� c li iii a: „.c,„„ . . .,.,4,,, , II; 4 s ^I_ 3 + sg F cn 8 n i. V ,� dg c ybC �'�C R �°� ]f 8 ' < Is 4n 1 l r c,.. , , 1Q a 1 411 4 _ Q y 3 RAC , � G EnA es 11:1i IR V . X 1 Xi \_ X M X 4 p Z ' O X spa z X n ' A ��. T Y 1 q^ti =>T X J F^' A 70 / ' R,t C F QQ C p 11 4 t 7t.� Q\\ n i. 4 w F Ic !I; R _.� a j. .,;. . 4. a T ``�\ ```&,.fix II .g. ` S re.:: e 7/ > E K ENGINEERING INC. DATE: 6/23/1 ',KW COnLS,RUC.;[X VP RE 81R SCHEDULE FOR DRAFTED BY- 1250 S, 1250 S-T, m P.O.BOX 3097 BATTLE GROUND.WA 98604 D.R.N. 1250 P & 1250 P-T PHONE: (360) 687-7668 FAX: (360) 687-7669 SCALE NTS HAGERMAN PRE CAST • 3•l. iY S�c� F4 i^ A^�� ccA SG'D-� O Z a4 NN (� n z n n �IA.Zn40�� ! ii�n A` x / iZ i'-T1CR= ST, rwjN <tV A .70RtT Sn+eNi,�ii0 r�+� UV C ;- S O' cJO d13 r <ffi�zN D fi3°'° $= fig N N�i> c g F k4s.ig~ i e; z IccA gFaz iR D n$m-. c3 id U DN_Q n rA5 43 ° t3 • ; A4e h Z ri.•r'il�o _ S ODO ` -�T C#y5�!� appt ,..-. �Yt r. 4A9q,,, i U, f ADn 1._,..11,„ 1 I y O 0• 1,g;-1Ataz tr. • A9q° 5. > a rr^ D 3<� dx c r p Q N n rn .. .Tr oM 00 mX I g Np ' ?)° Ai y=n gi — I w N t?7 dO O O2Q O 2q A Af, T Cf N DZ9 N -,� �n�yVC •P Z t WJ x T° 4"UF$Op 2i- / 65'!Pi054 1250P a',� II �' G 5'1250 5-T 4 1250 P-T O /• g z i. ! v j0 / 56'IHI T HEIGHT �' i < g 0 � y .__- --- -r—— \ \ p T(� I O -p,ti Vp� > c D 1 N P A C , I o �gg AL3ii $ zic,P,! i 4§g $jpp�^( 0"'.3 F e$71 z a =� ' n c V g 7-7 S 4 v 0,, N w Pge5 DPHiJ ii • I I. o • �y;i5 ,•A 2Q fT a.o g �`-�zsti III q S ' nD CD ' R 55 • :'-' — i t.N 2L� 2Z:z rs yn N O �/ Pl q ,5g ,� ,, sew 1 ., VED c:C f :r1'OUTIVT nJG"T n��A ��� b 1 5 z MAR 24;8"q5Zg7 Hf, � SON 202a • n NN SR fili N RON M EN- aw H , A• 8giA , ° „ - o r oR • • f; - oI,si woe " 3- •cn 4. EK ENGINEERING INC. DATE: 6/23/11 rANK DETNLs FOR MODELS DRAFTED BY: 1 250 S, 1250 S-T, to P.O.BOX 3097 BATTLE GROUND.WA 98604 D.R N 1250 P & 1250 P-T PHONE: (360) 687-7668 FAX: (360) 687-7669 SCALE: NTS HAGERMAN PRE-CAST Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION Permit Number SWG -Z 0Z .—p p ! 0 5 Parcel # 2z 4.'0‘S i Co?o 7 Applicant Name 6ea4Y k i I Subdivision (Name/Div/Block/Lot) Applicant Address 3 3 r SEAS Noi E 1N City, State, Zip S Eau/yvk 1,,y 4., 9'03te Z Installer Name 2 yiq-/ FLuS I' - Site Address 2-fS Al t#0E6STete LA! Designer Name UAl/riGtAin INSTALLATION CHECKLIST ❑ Full System Installation OTank(s)Only ❑ Drainfield Only Repair ❑Other System Type 6,4,v_ Pretreatment Type >5 ft. from foundation? - - ❑ NIA -YES ❑ NO >50 ft from wells? - 0 0 >50 ft from surface water? - IIIEME-H -1 ❑ ElZ H Cleanout between building and tank? --- - ElTank baffles present? - _ MAY 2El 24"access risers over each compartment?- ❑ a ey - ❑ W Effluent filter installed?- __� 0 ❑ Septic tank size 1 2r0 gal Manufacturer T746eie/'(i/1N gCa D-box water level and speed levelers used? ❑ N/A ❑ YES ❑ NO O Manifold/D-box accessible from surface?- - -- - - - - - 1,4_ _ _ mZ Check valves installed? - ❑ 0 0 OQ ❑ ❑ ❑ 2 Transport Line Size Schedule/Class Bedrooms installed (check one) ,2 0 3 ❑4 0 5 ❑6 ❑Commercial/Other >10 ft. from foundation?- - ❑ N/A ❑ YES ❑ NO CI >100 ft. from wells?- - 0 0 0 --I >100 ft. from surface water? - ❑ ❑ W ❑ Z >10 ft. from potable water lines?- - 0 0 0 7.1 > 5 ft. from property lines and easement - -_ A - 0 0 ❑ in > 30 ft. from downgradient curtain/foundation drains?- - El 0 Drainfield level and observation ports present - - ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - 0 ❑ ❑ Pump tank setbacks consistant with septic tank?- - 0 N/A ❑ YES 0 NO Pump tank size gal Manufacturer Z < 24"access riser(s)and accessible from surface?- - 0 0 0 a Alarm or Control Panel Installed? - - 0 ❑ 0 j Control Panel equipped with Timer/E Chu t�r- a Pump in ❑ ❑ ❑ installed ❑ Bucket or On Block or ❑ Other a Pump Make/Model I 0 Floats or ❑ Transducer a. Tank draw down a in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at qpd Updated 8/21/2018 Mason County OSS Installation Report pg. 2 Parcel# O Z`1a.6 51 oa ?O 7 • ABANDONMENT RECORD Were existing septic components abandoned as part of this project - - G YES El NO If yes, please describe: Pao ov7- 4 S Rtl ji Pe o AS J`O A'oelav-— Were all components pumped out and properly abandoned per WAC246-272A-0300? - - JES Ei 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: Drainheld&manifold orientation&layout,Septic/pump tank location,North arrow,reserve drainfield,existing and proposed buildings.location of wells,waterlines, wells,observation ports,cleanouts,and other maintenance access points. Incomplete Record Drawings may create additional delays in final installation approval and related permits, a! ,Record 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 -rtify that all information contained on this I further certify that all information contained on this fo and -tt: hi. Record Drawing is accurate. form and attached Record Drawing is accurate. f e4. Zc-15 111, Sign. '." of nstaller Date -2),,,„,/ , 4, Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: %)17 ---S Signature of Environmental dealth Specialist Date (stamp, signature and date) '821r20t8 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE F • Z24065/ 00 07 RECORD DRAWING (continu• .) tlj " 4' c°' • fi Y 81 ". f , I r 5,,wlf- ngir / ,ply / 7 '3 APPROVED MAY 10 2023 MASON COUNTY ENVIRONMENTAL HEALTF RET