HomeMy WebLinkAboutSWG2023-00200 - SWG Application / Design - 5/23/2023 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,EXT400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00200
APPLICANT DALE HASELWOOD Phone:
Address: 1938 W Deegan Rd E SHELTON, WA 98584
OWNER DALE HASELWOOD Phone:
Address: 1938 W Deegan Rd E SHELTON, WA 98584
SEPTIC DESIGNER PIONEER DIGGING INC Phone: 360-426-1803
Address: 3083 E MASON BENSON GRAPEVIEW, WA 98546
Site Address: 1938 W Deegan Rd E
Primary Parcel Number: 420257600040
Permit Description: New SFR-3BR Gravity
Permit Submitted Date: 05/23/2023
Permit Issued Date: 06/01/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/23/2026 (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.
1 OFFICIAL USE ONLY
MASON COUNTY0
DATE RECEIVED ��
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COMMUNITY SERVICES AM RE7D� ' RECEIVED 1 CO cn
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Public Health(Community Health/Environmental Health)
360427.9670,eat.400 or 36P275 4a67,eat.400 S W G O v V O
415 N. Street•�Shelton.WA 98584
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ON-SITE SEWAGE SYSTEM APPLICATION
m APPLICANT P:-ONE m
DALE HASELWOOD z
c
MAILING ADDRESS-STREET.CITY.STATE,ZIP CODE g
1038 W DEEGAN ROAD EAST SHELTON WA 98584 m
xi
SITE ADDRESS-STREET,CITY,ZIP CODE
1938 W DEEGAN ROAD EAST SHELTON WA 98584
NAME OF DESIGNER PHONE N
ROBERT H. PAYSSE 360-426-1803
NAME OF INSTALLER PHONE 0 CD
TBD
PERMIT0
{MI TYPE(select one) DRINKING WATER SOURCE - N
RESIDENTIAL OSS COMMUNITY OSS F COMMERCIAL OSS E PRIVATE INDIVIDUAL WELL I5f PRIVATE TWO-PARTY WELL Z 01
TYPE OF WORK(select one) 17 PUBLIC WATER SYSTEM I
W.NEW CONSTRUCTION/UPGRADES REPAIR I REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE IX REPAIR �l
SUBMITTALS ❑ SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE
CD
ICI DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE 0
5-WAIVE R(S)(IF APPLICABLE) 3 10.7 AC o .DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
OUT RAILROAD TOWARDS SHELTON MATLOCK ROAD. JUST BEFORE HWY 101 o
LEFT ON DEEGAN ROAD EAST. FOLLOW TO SITE ADDRESS 1938 ON RIGHT, SEE o I o
SITE PLAN. -
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. 0
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
t:VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ❑COMPLAINT 0 OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
0. :11 -1[—V(e(Ai0 /
MAY 23 2023
5(e g4- (s 7 _
RECORD DRAWING AND INSTALLATION REPORT
Sn"_CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
IN TOR SIGNATURE DATE APPLICATION EXPIRATION DATE ATION APPROVED/ISSUED BY DATE
.'‘ (AV AP\9/1/ '11' S. 5V )--(e. -flib(j) i\Aita\ - -2,19
T F.r AY 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 0 2 5 — 7 6 — 0 0 0 4 0
A design will be reviewed when 3 copies 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. v 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"
Permit Number: SWG_2,013 - oce 2.o 0 Designer's Name: ROBERT H.PAYSSE
Applicant's Name: DALE HASELWOOD Designer's Phone Number: 360-426-1803
Mailing Address: 1938 W DEEGAN RD EAST Designer's Address: 3083 E MASON BENSON RD
SHELTON WA 98584 GRAPEVIEW WA 98546
Ci State Zip City State Zip
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model ❑ Disinfection Unit Make/Model Other:
Drainfield Type
'Gravity 0 Pressure 'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 2729 PERF
Daily Flow: Operating Capacity 270 gpd Length 50 ft
Daily Flow:Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity(working) 1500 gal Number 3
Receiving Soil Type(1-6) 3 Separation 10 ft
Receiving Soil Appl.Rate 0.8 gpd/ft2 Orifices
Required Primary Area 450 ft2 Total Number of Orifices -
Designed Primary Area 450 ft2 Diameter - in
Designed Reserve Area 450 ft2 Spacing - in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 150 ft Schedule/Class 3034
Elevation Measurements � � �n� � � 20 ft
Original Drainfield Area Slope 10 a e 4 in
New Slope,If Altered 10 % iu Ibetr anifo figuration used? l'Yes 0 No
Depth of Excavation Up-slope 10 in Transport Pipe
from Original Grade Down-slope 7 ? A50�i nOUNTY E iRg$gi TC1TaAss HEALTH 3034
Designed Vertical Separation 36+ in 'i.engt 150 ft
Gravelless Chambers Required? 0 Yes El No 0 Optional Diameter 4 in
Pump Required? 0 Yes litfNo 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:Please check those required.
Capacity @ Total Pressure Head - gpm ❑Timer ❑Elapse Meter 0 Event Counter
Calculated Total Pressure Head - ft If Timer: Pump on - ,Pump off -
Comments C^o ,,t,'^/ 5f E(1a-trfy (J Ae S e t a c k
I
, DESIGN FORM—PAGE TWO Assessor's Parcel Number:4 2 0 2 5 — 7 6 -- 0 0 0 4 0
Permit Number: SWG
I DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
g Test hole locations g Drainfield orientation and layout Reference depth from original grade:
EZI Soil logs g Trench/bed dimensions and g Septic tank
g Property lines critical distances within layout E' Drainfield cover
g Existingand proposed wells gD-Box/Valve box locations
P P Reference depth from original grade
within 100 ft of property g Septic tank/pump chamber and restrictive strata:
VI Measurements to cuts,banks,and locations
g Laterals,trench/bed,top and
surface water and critical areas g Observation port location bottom
g Location and orientation of li Clean-out location 0 Curtain drain collector
curtain drain and all absorption g Manifold placement 0 Sand augmentation
components 64 Orifice placement Other cross-section detail:
g Location and dimension of g Lateral placement with distance g Observation ports/clean-outs
primary system and reserve area to edge of bed
B1 Buildings g Other Information
g Audible/visual alarm referenced Yes No
66 Direction of slope indicator g Scale of drawing shown on scale d 0 Design staked out
E t Waterlines 0 g Recorded Notices attached •
E� Roads,easements,driveways, P p O E�Waiver(s)attached
parkingEDo
❑ l�Pump curve attached
d North arrow and scale drawing ,f(�N 0 ' 20230 C�Evaluation of failure
shown on scale bar Non-residential justification
MAC COUNTY ENVIRONMENTAL HEALTH 0 Waste strength
JBN/ 0 El Flow
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DESIGN APPROVAL
The undersigned designer mus e notified by installer at time of installation El Yes 0 No
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Signature o Design Date
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in
compliance with state and local on- •te regulations:
vir�f'ii�ntaall�HHealth Specialist Date
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: .f 31- 40
✓ 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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SEPTIC TANK FUTURE WATERLINE 1
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9 MASON COUNTY ENVIRONMENTAL HEALTH
J B W AN ASBUILTI INSTALL SIGNOFF FEE WILL
�• BE CHARGED AT TIME OF INSTALLATION
PIONEER DICING INC. CUSTOMER DALE76-00040 HASE1 WooD I EST HOLE I: TEST HOLE 2 TEST HOLE 3:
PARCEL# 42025 ROOTS @ 48 ROOTS @ 48 46-54 SATURATED
SEPTIC DESIGNS ADDRESS: 1938 E DEEGAN RD ROOTS @ 46
DISCLAIIETr THIS IS NOT A SURVEY.REFERENCES INCLUDE APPLICANT/COUNTY PROVIDED
3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE PLATS OR SURVEYS.FIELD MEASUREMENTS AND COUNTY GIS DESIGN INTENDED FOR SEPTIC
OFFICE-360-426-1803 FAX•360-427-2353 SHEET: SITE PLAN SCALE 1"=100' PURPOSES
RTMENT//AGLENCY Y REVIEWO DESIGNER NOPROPSEDOT PMENT RESPONSIBLE FOR SETBACKS UNRELATEMAY BE SUBJECT 70 D TO
SEPTIC COI.00NENTS
P-BOX 4"3034
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AN ASBUILT/INSTALL SIGNOFF FEE !"_'_
BE CHARGED AT TIME OF INSTALLATION
PIONEER DIGGING INC. CUSTOMER: DALE HASELWOOD TEST HOLE I: 1 EST HOLE 2: TEST HOLE 3:
PARCEL#:42025 76-00040 0-56 GIS 0-64 CIS 0-46 GIS
Roo 1 S @ 48 ROOTS @ 48 46-54 SATURATED
SEPTIC DESIGNS ADDRFSS: 1938 E DEEGAN RD ROOTS @ 46
3083 E MASON BENSONRD. GRA'EVIEW,WA 98546 DESIGNER ROBERT H.PAYSSE P ORS THIS ED 'REN`� �PROVIDED
PLAT SURVEYS FIELD MEASMN REFERENCES YAPPLICANT/COUNTY
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OFFICE-360 426 Ip03 FAX 360 427 2353 PMENT MAY BE SUBJECT TO DINER
DEPPURARTMENT/AGENCY MENT/AGENCY REVIEW DESIGNOSES ONLY PROPOSED ER NOT ESPONS BLE FOR SETBACKS UNRELATED TO
SHEET: DF DETAIL SCALE I"=10' SEPTIC COMPONENTS
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Iinstallation & System Notes
1. Installer must contact designer for final inspection of the installation prior to cover. All components, including tanks, lids,
transport line,drainfield,and water lines must be open for inspection. A$350.00 fee will be charged for time involved with the
inspection of the installation and creation of the record drawing. The designer reserves the right to charge additional fees if
multiple visits are needed due to installation errors or inaccessible components.
2.This septic design must be installed by a certified installer with the local health department. All components shall be installed
according to state, county,and manufacturer requirements. For Homeowner Installs,the owner must get approval from the
designer and local health department prior to attempting installation.
3. Designer is not a surveyor. Installer must familiarize themselves with property line locations prior to installation. Any
confusion or conflicts with line locations should be reported to the property owner. A licensed surveyor may be necessary prior
to installation to confirm all line locations. Any discrepancies found must be reported to the designer immediately.
n. Drainfield area may only be cleared by a licensed installer familiar with sensitive drainfield area preservation. The builder, lot
developer,or property owner shall not clear the drainfield area. Any clearing required for drainfield installation shall not
remove or disturb any top soil in Primary and Reserve areas. Removal or disturbance to drainfield soils could render design
void.
5.The property owner and installer are responsible for locating all underground utilities (ex. water,gas, electric) prior to
installation. Any utility locations shown within design drawings are likely approximate and may not be exact.
6. All proposed tanks must be installed on original soils or compacted gravels. Extend all tank connection lines out onto original
soil to avoid settling issues. Risers and lids must be brought to finished grade and left accessible for future operations and
maintenance. Component manufacturers (ex. ATU, Glendons,) may have other requirements not listed within this design.
7.All electrical wiring shall be done by a licensed electrician or homeowner(if allowed)and must be permitted through Labor
II and Industries.
8.The proposed septic system should be installed in dry weather conditions. Any failed attempts at installation during wet
weather conditions may render this design void.
9. Maintain loft to waterlines with all septic components. If less than 10ft is required, sleeving in sch.40 pvc is required. If
sewage transport lines and waterlines must cross,waterline must be 18" above sewage line with one of the lines sleeved in sch.
40 pvc 10ft in each direction of crossing.
10.This design may include waiver applications with specific mitigation measures pertaining to installation,operation and
maintenance of the proposed components.
11. Stormwater runoff,footing drains, roof drains must be diverted away from any septic system components. No curtain,
foundation, perimeter drains shall be installed 30ft downslope and loft upslope of drainfield areas.
t7 This design is site specific and intended to meet state and county requirements that are related to the system components
being proposed. Any placement of proposed buildings, proposed wells or other non-related items on these drawings may or
may not meet other requirements.
13.All onsite septic systems require regular maintenance to verify satisfactory operation. ys +r / erator is
responsible for the continuous operation and maintenance of the system per WAC 246- or operal i ance
information, refer to Mason County Public Health Homeowner's Manual,which should r ived fi r' stallatl6n . ‘" '=
�s 11' .
14. System owner should be cautious of landscaping around septic components. Root intr siocPUNTyFN,� ?0?3 tiI
can cause premature failure of the drainfield area. In addition, bushes and trees should be kept Jet oAiM6-A,, y�A�rH`
away from lids and other septic maintenance points. ,V
i.
15. Changes made at time of installation may impact designer calculations, pump sizing,and •
t i,
compliance w/county and state requirements. Contact designer prior to install w/any �t ' '
proposed variations from design. Changes may result in additional fees and permitting. ,.TNIL
PIONEER DIGGING INC. CUSTOMER: DALE HASELWOOD :: •; ,
SSC03I7 ;:\i
PARCEL# 42025 76-00040 O ROBERT N PAYSSE . `
SEPTIC DESIGNS ADDRESS: 1938E DEEGAN RD 16
1� I'- '. ,�Ir��
3083 E.MASON BENSON RD. GRAPEVIEW,\VA 985•R, DESIGNER: ROBERT H.PAYSSE EXPifi.S
OFFICE-360-426-1803 FAX-360-427-2353 SHEET: NOTES SCALE NA I