HomeMy WebLinkAboutSWG2023-00162 - SWG Application / Design - 5/1/2023 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 Permit: SWG2023-00162
APPLICANT FOUTS GEORGE B & DEBORAH M Phone:
Address: PO BOX 858 BELFAIR, WA 98528
OWNER FOUTS GEORGE B & DEBORAH M Phone:
Address: PO BOX 858 BELFAIR, WA 98528
SEPTIC DESIGNER Jim Zimny -Advantage Perc & Design Phone: 360-516-7287
Address: 7178 WINDFLOWER PL NW SEABECK, WA 98380
Site Address: 130 NE Bryan Ln
Primary Parcel Number: 223365100005
Permit Description: 3-bedroom gravity system repair
Permit Submitted Date: 05/01/2023
Permit Issued Date: 05/08/2023
Issued By: David Anderson
Current Permit Fees Paid: $780.00 (additional fees may be required 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 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.
s OFFICIAL USE ONLY
DATE RECEIVED
MASON COUNTY b ' L '�o
f i COMMUNITY SERVICES AM«JNTfEt� �.C' ��"�D� o m
14 PubUCHealth(Community Health/Environmental Health)
aeo-a2�9e�o,exteoo«wnsaw�,�rtaoo SWG ►/��) �J/��/��1/
415 K 6th StreK-Sllekon,WA 98584 / Q`!a`� - GC L - �` Z 53
CLEQF? FORM ON-SITE SEWAGE SYSTEM APPLICATION z
II
m 73
n
APPLICANT PHONE R1
George Fouts 360-801-5685 �T Z
s c
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE
PO Box 858, Belfair WA 98528 S m
71
SITE ADDRESS-STREET,CITY,ZIP CODE O
130 NE Bryan Ln, Belfair Wa 98528 N
NAME OF DESIGNER PHONE
Jim Zimny 360-516-7287 (.' Iry
NAME OF INSTALLER PHONE 0 I' /�1
•
PERMIT TYPE(select one) DRINKING WATER SOURCE N I vv )
k RESIDENTIAL OSS f COMMUNITY OSS n COMMERCIAL OSS n PRIVATE INDIVIDUAL WELL I7 PRIVATE TWO-PARTY WELL Z
TYPE OF WORK(select one) 2 PUBLIC WATER SYSTEM Lynch Cove Water
1
to NEW CONSTRUCTION/UPGRADES PR REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE CI SHORELINE COV
W'DESIGN FORM(REQUIRED) PI SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r I '
1.WAIVER(S)(IF APPLICABLE) 3 .22 Acres 0 t
DIRECTIONS TO SITE AND SITE CONDITIONS(e% locked gate) I O
9 From Belfair travel 2.3 Miles and Take Left on Lorna Lee Way. 14
Take immediate rt on Bryan Ln. Lot is 800 Ft On Rt.
9 Test Holes on on the east side of home behind the fence. o Ia
io
SITE MUST BE FLAGGED FROM MAIN ROAD ANO TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS I C
OFFICIAL USE ONLY BELOW THIS LINE l
f
UPGRADE/FAILURE SOURCE(for reporbng purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ['OTHER:
INSPECTOR SOIL LOGS COMMENTS 1 CONDITIONS
ti
1
b
1 ..1. 16
TH1: 0-6 / IPI I
CD
c
1
1 r�
1 sc..0 S
1
II
r
i RECORD DRAWING 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 SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
_ s/3/2o 1 5/3/z016
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 1 n2O1S
%
DESIGN FORM—PAGE ONE Assessor's Parcel Number 223365100005- —
A design will be reviewed when 3 conies of each of the following are submitted:
Completed design form that has been signed and dated. v 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"
PARCEL IDENTIFICATION
Permit Number: SWG 60l(�Qa Designer's Name: Jim Zmny
A licant's Name: Geor a outs Designer's Phone Number: 360 5t6 7287
PP
Mailing Address: PO Box 8587178 Windflower PI NW
Designer's Address:
Belfair WA 98528 Seabeck WA 98380
CLEAR FORM
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device
0 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
'Gravity 0 Pressure 0 Trench leBed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 ,„. Schedule/Class 3034
Daily Flow:Operating Capacity 360.270 0 gpd Length 45 ft
Daily Flow: Design Flow 27°360 f 4gpd Diameter 4 in
Septic Tank Capacity(working) 1200 gal Number 3
Receiving Soil Type(1-6) 3 Separation 30" ft
Receiving Soil Appl.Rate 0.8 gpd/ft2i Orifices
Required Primary Area 450 ft c Total Number of Orifices NANA
Designed Primary Area 450 ft t/ Diameter in
Designed Reserve Area NA ft2 ,- Spacing „►s in
Trench/Bed Width 10 ft V 4. .% Manifold
+
Trench/Bed Length 45 ft I Schedui-�i : '++
•
Elevation Measurements Lena � 'r II! ft
Original Drainfield Area Slope 0 % Di..1.- Tcsf-to ot tEfl . in
il
New Slope,If Altered 0 % Pre ferred'rnanifo d 0:1-1 iguration used? El Yes ❑No
Depth of Excavation Up-slope 24 in Transport Pipe
from Original Grade Do ,_siOC 24 in Schedule/Class 3034
Designed Vertical Separation 36 in i Length 15 ft
Gravelless Chambers Required? 0 Yes 0 No 'Optional Diameter 4"
Er in
Pump Required? 0 Yes 'No Dosing and Pump Chamber
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 0 Higher 0 Lower than Pump Shutoff Pump controls:P1e «. : tire AP
Capacity(0.Total Pressure Head gpm ❑Timer A ill .+%."5NEIL=lj 0 Event Counter
Calculated Total Pressure Head ft If Timer: Pump on ,Pump off
Comments MAY 0 n023
MASON COUNTY ENVIRONMENTAL HEALTH
DJA
DESIGN FORM—PAGE TWO Assessor's Parcel Number:223365100005- --
Permit Number. SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
IFS Test hole locations g Drainfield orientation and layout Reference depth from original grade:
Lot Soil logs lEi Trench/bed dimensions and Er Septic tank
O Property lines critical distances within layout is Drainfield cover
Ei Existing and proposed wells Er D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 16 Septic tank/pump chamber and restrictive strata:
fa Measurements to cuts, banks,and locations VI Laterals,trench/bed,top and
surface water and critical areas RC Observation port location bottom
O Location and orientation of lig Clean-out location 0 Curtain drain collector
curtain drain and all absorption ❑ Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
g Location and dimension of Lvf Lateral placement with distance•
V Observation ports/clean-outs
primary system and reserve area to edge of bed
ET Buildings
Other Information
Buildings
0 Audible/visual alarm referenced Yes No
d Direction of slope indicator V Scale of drawing shown on scale 0 ❑ Design staked out
P1 Waterlines bar 0 0 Recorded Notices attached
V Roads,easements,driveways, a �1 lo( El Waivers)attached
parking ' 0 0 Pump curve attached
%� • �'• 0 0 Evaluation of failure
Lf North arrow and scale drawing ' •.:,?'�° )
shown on scale bar .40 err � 1� Non-residential justification
'off '33 �ti 0 0 Waste strength
i LI : S ►DES'GNER
.i. 'zs....a 0 ❑ Flow
ExDL it;L 7 11, S
DESIGN APPROVAL
The undersigned designer must be notified b . Iler time of installation N1 Yes 0 No
y- 2I23
Signatu esigner Date //�� �� ((������
The undersigned has reviewed this design on behalf of Mason County Public Health anAe#erl Ei t + t riE
compliance with state and local on-site regulations:
SNerl� MAY 082023
En nmental Health Specialist DitttSOM'COUNTY ENVIRONMENTAL HEALTH
DJA
I 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
_I
i
[Li -,
e: M :- '• 0 r..1 ') J 0 rn
cv ,=��gt5�` W Q. p� C 0 c O
E ® o a O ., `o v O rC 0 N
`�' 0 ao �., + o� �' ° d �� m Q ON O
Z. Q . . '`k%ker W u i c a Z m = II
V a�,
J p � � QU * 0 a N
a?
0
-0
a)
CV
a) ` * 86' z
p I- �,1 1.--
/
''. :1� .. il, O I
/
•
+ t
` q
ra
a3 t
%U ,
Q
a)
N
co
171 I t
a)
a O a+ E 4c)
�' f a, 0
3J
0 D a� I
c EAn =
s N ac 0 — ft
i
Ui �
X0
b.- 11.+ • 0
0 a 0 CO
Z . N 0
Q � W Z
0 Z
(NI
rn
a1
C
X
w
........._—., ........
���' -a ...�
et
�� `,,,.....
`
ra
to
.
O . E E
. aS
0
0•
s -/ — �
— ` J
`• a) a)
,98
` � o '
```_ `•• = `D NJ= i
•. F— O F— O
•
• S. •
.
Advantage Perc & Design
Timely-Reasonable-30 Years of Local Experience
Construction Notes for 3 Bedroom Gravity System
Gravity w/graveless chambers (Rock and pipe may be substituted)
Install 10' x 45' bed w/3 laterals.
Use a 4 hole d-box and speed levelers
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.
Use existing 1200-Gallon septic tank
System designed for typical residential waste strength sewage only. "
System designed for 360 Gallons Per Day
.red ��ar.,33 Air r 1.
:`"r `"1 LES!GKER
Ex ire, �'`t�` ��� f
APPROVE;
MAY 0 8 2023
MASON COUNTY ENVIRONMENTAL HEALTH
DJA
4
Advantage Perc&design 0 APDdesignspicloud.com 0 (360) 516-7287
. 1
& \ 7 ci
2zo SO _
o-m c.
a o. � k�� o
NI
t k ®}%s? § L 2_ 2 t
VI ildc ��I�� ) o 7 °
a £ q22§ ¥ M e , 2
k f$N.�e � 2t R
/5-:c014
A".
. ;1
2 f - cI
-
'1'::44:!.i-
41::0..,%1:11
/ . \ I
-rccit III
2 :K 7;\
E S.
k $ `:
2 „v (,r:::e):.
C ƒ k /
-
2 /
a > 5
f 7
$ :-5'
4
J _ 0
\ 11. CD
¥
V)I
.
L..f .A. I 32
■ / / /�� - �i ,kk
tv k \
�� 2• it: . E
kJ
I
| ®V k -.� VI
| k0 i \
_ _ I | 1 , ƒ A Da.
Ai
V §2 $ �afI
( \ 2 | \ a Ku ¢
\ \ }� � }/ /
I �# . � ? 00
5 | f I I. \}
c I _ I k *
: I. § 1 ,__ ƒ?
, vi
RO % | 2 `a
| L.
§
N « •
e
n