HomeMy WebLinkAboutSWG2023-00158 - SWG Application / Design - 4/28/2023 MASON COUNTY 415 N 6TH STREET, SHELTON,WA 98584
• SHELTON:360-427-9670, EXT 400
a>; 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: SWG2023-00158
APPLICANT PRICE CHARLES D & MARLA RAE Phone:
Address: 60 NE BARBARA LN BELFAIR, WA 98528
OWNER PRICE CHARLES D & MARLA RAE Phone:
Address: 60 NE BARBARA LN BELFAIR, WA 98528
SEPTIC DESIGNER Jim Zimny -Advantage Perc & Design Phone: 360-516-7287
Address: 7178 WINDFLOWER PL NW SEABECK, WA 98380
Site Address: 60 NE Barbara Ln
Primary Parcel Number: 223365400052
Permit Description: 3-bedroom gravity system repair
Permit Submitted Date: 04/28/2023
Permit Issued Date: 05/04/2023
Issued By: David Anderson
Current Permit Fees Paid: $780.00 (additional fees may be requi•ed upon installation of system).
Permit Expiration Date: 05/03/2026 (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 Drainfield 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/environmentallonsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLYDATE RECEIVED:
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`� �� MASON COUNTY 0) D
o tv COMMUNITY SERVICES AMOUNT•
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-`~ Public Health(Community Health/Environmental Health) ' ✓ CA
360-427-9670,en 400 or 36onsa467,«c 400 SWGC fn
415 K 6th Street-Shelton,WA 985II4 ^ - - o t1 1 5[� O 0
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION z 13
APPLICANT PHONE m m
Charles Price 360-801-4480 j- . z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE C
60 NE Barbara Ln , Belfair Wa 98524
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SITE ADDRESS-STREET,CITY,ZIP CODE � •
60 NE Barbara Ln , Belfair Wa A8 (- N
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NAME OF DESIGNER PHONE C
Jim Zimny 77'nnt7 R U 360-516-7287 r N
NAME OF INSTALLER GZU` '" adV PHONE
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PERMIT TYPE(select one) . ._ { DRINKING WATER SOURCE 0
A RESIDENTIAL OSS COMMUNITY OSS fl COMMERCIAL OSS I7 PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z
TYPE OF NVRK(select one) 2 PUBLIC WATER SYSTEM t
to NEW CONSTRUCTION/UPGRADES tq REPAIR/REPLACEMENT OTHER DETAILS(select elf that apply) 0 TABLE IX REPAIR �1
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE co
DESIGN FORM(REQUIRED) (Pi SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r
^ t
l�WAIVER(S)(IF APPLICABLE) 3 1 Z V
C)
DIRECTIONS TO SITE AND SITE CONDITIONS(ex kxked gate)
From Belfair go 3.4 miles on Northshore to Larsen Lk rd take rt. In 250 ft take left onto
Mathews dr. In .2 miles take left onto Barbara Blvd, in 600 ft take left onto Barbara Ln.
House is 300 ft on Rt. o 0
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUSE BE FLAGGED WIT(TEST HOLE NUMBERS. r
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ❑COMPLAINT 0 OTHER:
INSPECTOR SOIL LOGS COMMENTS I CONDITIONS
Ttt 0-61''L m S
TNZ- 0- 6Z`` Lih5
RECORD DRAWNG 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.
INSPECTOR NATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
_S//0Z 313 /20?6
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PU*UC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7QQO1S
DESIGN FORM—PAGE ONE Assessor's Parcel Numberr�233654O0052— —
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: II"Y 17"
PARCEL IDENTIFICATION
Permit Number: SWG f ' v MM V`CDC6, Designer's Name: Jim Zimny
Applicant's Name: Charles Price Designer's Phone Number. 360 516-7287
Mailing Address: 60 NE Barbara Designer's Address: 7178 Windflower PI NW
Beltair,WA 98524 Seebeck WA 98380
CLEAR FORM
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
l'Gravity 0 Pressure 0 Trench aP"Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 V z Schedule/Class 3034
Daily Flow:Operating Capacity 360 gpd✓ Length 25' ft
Daily Flow: Design Flow 270 gpd ✓ Diameter 4" in
Septic Tank Capacity(working) 1200 gal." Number 3
Receiving Soil Type(1-6) 3 l` Separation
18" ft
Receiving Soil Appl.Rate 0.8 gpd/ft2 ,t Orifices
Required PrimaryArea 450 ft21// Total Number o;c r�-s NA
q ./ i+1
Designed Primary Area 450 {}2 Diameter 0r...., �1'� in
r
Designed Reserve Area NA ft2 Spacing %; ,� s�33 ,1 in
Trench/Bed Width 9(2) ft !/ �� . oEsicNER 1 anifold
Trench/Bed14,
Length 25(2) ft �/ Schedul<' ro 'iv"� "• NA
Elevation Measurements Length
ft
Original Drainfield Area Slope 2% % Diameter in
New Slope,If Altered 2% % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slope 24 in Transport Pipe
from Original Grade wn_siope 24 in Schedule/Class 3034
Designed Vertical Separation 36 " in Length 10' ft
Gravelless Chambers Required? 0 Yes 0 No Lu'Optional Diameter 4��
in
Pump Required? 0 Yes seNo Dosing and Pump Chamber
4 Pump/Siphon Specifications Number of doses/day
Diff. in Elevation Between Pump&Uppermost Orifice ft Dose quantity gal
Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity (flood) gal
Uppermost Orifice Cl Higher 0 Lower than Pump Shutoff Pump controls:Please check t sqj 0NLE
Capacity C Total Pressure Head gpm OTimer to linter
Calculated Total Pressure Head ft If Timer: Pump on ,Pump off
Comments
MASON COUNTY ENVIRONMENTAL NEALI.''
DJA
. DESIGN FORM—PAGE TWO Assessor's Parcel Number.�23365400052 — —
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
P, Test hole locations 0 Drainfield orientation and layout Reference depth from original grade:
Er Soil logs P1 Trench/bed dimensions and Fr Septic tank
O Property lines critical distances within layout la' Drainfield cover
0 Existing and proposed wells V D-Box/Valve box locations Reference depth from original grade
within 100 ft of property Er Septic tank/pump chamber and restrictive strata:
O Measurements to cuts, banks,and locations E( Laterals,trench/bed,top and
surface water and critical areas 0 Observation port location bottom
O Location and orientation of 0 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption ❑ Manifold placement 0 Sand augmentation
components
0 Orifice placement Other cross-section detail:
0 Location and dimension of 0 Lateral placement with distance V Observation ports/clean-outs
primary system and reserve area to edge of bed
of Buildings Other Information
0 Audible/visual alarm referenced Yes No
0 Direction of slope indicator Er Scale of drawing shown on scale 0 0 Design staked out
V Waterlines bar 0 ❑ Recorded Notices attached
e1 Roads,easements,driveways, t' V 0 Waiver(s)attached
parking ; �It,i 0 0 Pump curve attached
El North arrow and scale drawing 4� --- 0 0 Evaluation of failure
shown on scale bar �'
.� '`'�� Non-residential justification
.2` / , �1'' ❑ 0 Waste strength
• ° •
;';', 0 ❑ Flow
DESIIN'P' o .AL
The undersigned designer must be notified by installer at time of installation VYes ❑ No
iI 41/25 /? "2)
Signature biD gner Date
The undersigned has reviewed this design on behalf of Mason County Public Health and detc'n!inIIflVE
compliance with state and local o gulations: /Y/? .Z3MAY 0 4 2023
+►msvN COUNTY EN +t -�� .-
Environmental Health Specialist DateVIRONMEN,A[h_
DJA
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:
✓ 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
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Timely•Reasonat e•30 Years of Local Experience
Construction Notes for 3 Bedroom Gravity System
Gravity w/graveless chambers (Rock and pipe may be substituted)
Install 2—9'x25' beds.
Use a 3 -4 hole d-box and speed levelers
Install on 1'from existing drainfield.
Install 24"trench depth on low side of trench and maintain 36" of vertical separation
Install level and along contours.
Install in dry weather only. APPROVED
Use existing 1200 gallon septic and add risers for pumping and maintenance MAY 0 4 2023
System designed for typical residential waste strength sewage only. MASON COUNTY ENVIRONMENTAL HEALTH
System designed for 360 Gallons Per Day DJA
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MAY 0 4 2023
MASON COUNTY ENVIRONMENTAL HEALTH %� III'
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C%„tlC�SED DESIGNER
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