HomeMy WebLinkAboutSWG2023-00133 - SWG Application / Design - 4/12/2023 584
MASON COUNTY 415 N 6TH STREET,SHELTON, ,E 98400
SHELTON: ,S 42 TON, ,EXT 400
(011, BELFAIR:360-275-4467,EXT 400
e� Public Health & Human Services ELMA:360-482-5269,EXT 400
ws " FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00133
APPLICANT Karl &Teresa Miller Phone:
Address: PO Box 42 HOODSPORT, WA 98548
SEPTIC DESIGNER DALE TAHJA-Septic Designer Phone: 360-426-5940
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: 330 N Schoolhouse Hill Rd
Primary Parcel Number: 422114400390
Permit Description: New SFR -3BR Pressure
Permit Submitted Date: 04/12/2023
Permit Issued Date: 05/02/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $780.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 04/20/2024 (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.
l
— OFFICIAL USE ONLY
MASON COUNTY DATERKENED ` ' ^ ` 245
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AV COMMUNITY SERVICES AMQ ED: L RECEIVEDW?• 0_ m
Public Health(Community Health/Environmental Health) D • 17 En
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415N.6thStr et-400ltn,WA 98584 cxt.400 SWG O . - Ob 13�, o
415 N.6th Street-Shelton,WA 9E584
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ON-SITE SEWAGE SYSTEM APPLICATION v
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APPLICANT PHONE m
Karl & Teresa Miller (360) 490-8881 c
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 3
P.O. Box 42 Hoodsport WA 98548 co
SITE ADDRESS-STREET,CITY,ZIP CODE
330 N. Schoolhouse Hill Rd. Hoodspoprt WA 98548 14"
NAME OF DESIGNER PHONE I N
Dale L. Tahja (360) 426-5940
NAME OF INSTALLER PHONE 0 I N
T.J. Goos (360) 490-0217 R
PERMIT TYPE(select one) DRINKING WATER SOURCE
trl:RESIDENTIAL OSS E.COMMUNITY OSS ET COMMERCIAL OSS b PRIVATE INDIVIDUAL WELL ff PRIVATE TWO-PARTY WELL Z
H
TYPE OF WORK(select one) P)PUBLIC WATER SYSTEM Hoodsport Water System
q� I
ENEW CONSTRUCTION/UPGRADES fifi REPAIR/REPLACEMENT OTHER DETAILS(select ell that apply) 21 TABLE IX REPAIR I
11 SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE al
LMiDESIGN FORM(REQUIRED) iffSEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE cor I -P
57WAIVER(S)(IF APPLICABLE) 3 1.84 acres 6 I o
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
Leave Shelton north on Hwy 101 to Hoodsport, turn left on Schoolhouse Hill Rd., property I I o
on the right. o I w
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I O
---— — OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT El HOME SALE ❑COMPLAINT ❑OTHER: Ai
10
INSPECTOR SOIL LOGS -l ^^ COMMENTS/CONDITIONS `� '
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APR 1 2 2023 u 't;t‘ b t' '�. 8 t ; �1
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RECORD DRAWING AND INSTALLATION RE \�,
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
IN80-CTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APyMATION APPROVED/ISSUED BY DATE
(./ (ikAkii\ Li -141 -2.3
cycitLk\f‘,4\-1,
M T S FO MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 4 2 2 1 1 — 4 4 — 0 0 3 9 0
A design will be reviewed when 3 conies 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: 11"X 17"
• PARCEL;IDENTIFICATIOhi .
Permit Number: SWG 2023-00133 Designer's Name: Dale Tahja
Applicant's Name: Karl&Teresa Miller Designer's Phone Number: (360)426-5940
Mailing Address: P.O.Box 42 Designer's Address: 2450 W Deegan Rd W
Hoodsport WA 98548 Shelton WA 98584
City State Zip City State Zip
DESIGN PARAMETER _,
Q)3 Treatment Device
❑Glendon Biofilter 0 Sand Filter ound 0 Sand Lined Drainfield in Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: N/A
Drainfield Type
❑ Gravity 'Pressure NI Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4 Schedule/Class Sch. 40
Daily Flow:Operating Capacity 360 gpd Length 40, 50, 60 ft
Daily Flow: Design Flow 480 gpd Diameter 1.25 in
Septic Tank Capacity(working) 1,250 gal Number 5
Receiving Soil Type(1-6) 4 Separation 9 ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 800 ft Total Number of Orifices 68
Designed Primary Area 800 ft2 Diameter 1/8 in
Designed Reserve Area 800 ft2 Spacing 48 in
TrenchBBed Width 3 ft Manifold
Trench/Bed Length 270 ft Schedule/Class Sch. 40
Elevation Measurements Length 180 ft
Original Drainfield Area Slope 0 % Diameter 1.25 in
INew Slope,If Altered 0 % Preferred manifold configuration used? 0 Yes 6 'No
Depth of Excavation Up-slope 6 in Transport Pipe
from Original Grade Down-slope 6 in Schedule/Class Sch. 40
Designed Vertical Separation 24 in Length 20 ft
Gravelless Chambers Required? 0 Yes 0 No 14Optional Diameter 2 in
Pump Required? liv.i Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 4
Dif ., in Elevation Between Pump& Uppermost Orifice 5 ft Dose quantity 90 gal
Drainfield Squirt Height/Selected Residual(head) 7 ft Chamber Capacity(flood) 1,200 gal
Uppermost Orifice FYI Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 30 gpm lifTimer I 'Elapse Meter ['Event Counter
Calculated Total Pressure Head 16 ft If Timer: Pump on 3 min. ,pump off 5 hrs 57 min
Comments PPROVE
MAY 0 5 2023
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
DESIGN FORM—PAGE TWO Assessor's Parcel Number:4 2 2 1 1 — 4 4 -- 0 0 3 9 0
Permit Number: SWG 2023-00133
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
E6 Test hole locations 6d Drainfield orientation and layout Reference depth from original grade:
O Soil logs 0 Trench/bed dimensions and 0 Septic tank
g Property lines critical distances within layout 0 Drainfield cover
171 Existingand proposed wells 0 D-Box/Valve box locations
p p Reference depth from original grade
within 100 ft of property 0 Septic tank/pump chamber and restrictive strata:
O Measurements to cuts, banks, and locations 0 Laterals,trench/bed,top and
surface water and critical areas 0 Observation port location bottom
0 Location and orientation of 0 Clean-out location 0 Curtain drain collector
curtain drain and all absorption 0 Manifold placement 0 Sand augmentation
components
g Orifice placement Other cross-section detail:
0 Location and dimension of g Lateral placement with distance 0 Observation ports/clean-outs
primary system and reserve area to edge of bed
Pi Buildings Other Information
Audible/visual alarm referenced Yes No
0 Direction of slope indicator 0 Scale of drawing shown on scale d ❑ Design staked out
0 Waterlines bar 0 0 Recorded Notices attached
O Roads,easements,driveways, PPROVE ❑ ❑ Waiver(s)attached
parking 0 0 Pump curve attached
0 North arrow and scale drawing ❑ ❑ Evaluation of failure
shown on scale bar AMAY 0 5 2023 Non-residential justification
'.1ASON COUNTY ENVIRONMENTAL HEALTH 0 0 Waste strength
JB{l�/ 0 ❑ Flow
DESIGN APPROVAL
The undersigned designer must be notified b •' s at time of installation gi Yes 0 No
Signature of Designer Date ter", , ,
-
The undersigned has reviewed this design on behalf of Mason County Public Health and determil6 :s se in :w �.
compliance with state and local • .ite reg�ulllation�ss:� .`�tI`� Q ujLA,C '
_, . --.2._. ..3
ri MI mental Health Specialist DateN'4 . -1:,,di , L}
CAUTION: DESIGN • ' 'ROVAL IS VALID ONLY UNDER THE FOLLOWING CO 11 '2 ► : •i.. ;�
✓ The design is stamped"Approved"by Mason County Public Health. ►t �is,
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: V" (�— 2.4 • il'(' p.
s( Drainfield site conditions have not been altered to adversely affect conditions of design approval. .,;.;2,
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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Installation/Maintenance
Pressure Distribution/Trench Systems
1. Install trench bottom level and in contour with the ground.
2. Install drainfield during dry weather and soil conditions.Any soil smearing must be
eliminated by hand raking any areas that get smeared.
3. Install audio/visual high water alarm.
4. Install effluent filter in septic tank outlet or pump vault with 1/16 inch maximum
filtration mesh size.
5. Install check valve in pump outlet line to prevent back-flow into the pump chamber.
6. Install 1/8 inch orifices on 4ft. centers. Install the orifices (with orifice shields)pointing
straight up ( 12:00 o' clock).
7. Divert all storm water run-off away from septic system components.
8. No curtain(french) drains allowed within l Oft, of the up-slope edge of the drainfield and
reserve area.
9. No curtain(french) drains allowed within 30ft. of the down-slope edge of the drainfield
and reserve area.
10.Have the septic tank and pump chamber pumped or inspected every 3 to 5 years.
11.Inspect and clean pump screen as needed.
12.Inspect floats and test high water alarm every 6 to 12 months or as needed.
13.All material and workmanship must meet County and State requirements.
14.Install risers on septic tank and pump chamber.
15.Deviation from this approved design without prior approval from the Designer and
Mason County Health Department will make this design null and void.
16.The prepared Site Plan is not a survey, it is the owner's responsibility to verify property
line locations prior to installation. Any discrepancies must be reported to the Designer
immediately.
17. Locate all utilities prior to starting installation.
0-4 jPPROVE
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