HomeMy WebLinkAboutSWG2023-00210 - SWG Application / Design - 5/30/2023 MASON COUNTY 415 N 6TH STREET, 0427 ON,967 , A 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: SWG2023-00210
APPLICANT ROBERTS MICHAEL A & ANGELA M Phone:
Address: 1540 NE OLD BELFAIR HWY BELFAIR, WA 98528
OWNER ROBERTS MICHAEL A & ANGELA M Phone:
Address: 1540 NE OLD BELFAIR HWY BELFAIR, WA 98528
SEPTIC DESIGNER Jim Zimny -Advantage Perc & Design Phone: 360-516-7287
Address: 7178 WINDFLOWER PL NW SEABECK, WA 98380
Site Address: 1540 NE OLD BELFAIR HWY
Primary Parcel Number: 123201201160
Permit Description: Repair 3bd gravity trench
Permit Submitted Date: 05/30/2023
Permit Issued Date: 06/05/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $780.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/01/2024 (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 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.govlhealth/environmentallonsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
•
OFFICIAL USE ONLY
DATE RECEIVED:
MASON COUNTY 5 3 aO23 0 7.
AEI COMMUNITY SERVICES RECEIVED BY: C W
�^ wa
Public Health(Community Health/Environmental Health) •�, Cl'�•' • C
4315 N.6th Street
e -400 a 36P17S434 ext.400 S W^ )-,`1 ^ 3 O 2
415 N.6th Street-Shekrm,WA 96i8M1 /V U r(V-J1T, t'v��(\{`J` IV`
Z 6
ri FAR FORM ON-SITE SEWAGE SYSTEM APPLICATION v
m
APPLICANT PHONE III
Mike Roberts 206-290-359 O �MEV c
MAILING ADDRESS-STREET,CITY,STATE.ZIP CODE 1 g
1540 OLD BELFAIR HWY, Belfair WA 98528 °°
MAY 2013 L- m
SITE ADDRESS-STREET,CITY,ZIP CODE
1540 OLD BELFAIR HWY, Belfair WA 98528 BY:
NAME OF DESIGNER PHONE
Jim Zimny 360-516-7287 IN
NAME OF INSTALLER PHONE 0 IV\:
<rn I(N
PERMIT TYPE(select one) DRINKING WATER SOURCE
RESIDENTIAL OSS ri COMMUNITY OSS el OSS tt�f PRIVATE INDIVIDUAL WELL 6 PRIVATE T1NO-PARTY WELL z
i I
TYPE OF WORK(select one) L.r PUBLIC WATER SYSTEM
WORK r
b.NEW CONSTRUCTION I UPGRADES PREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) El TABLE IX REPAIR ( —
SUBMITTALS ❑SURFACING SEWAGE El EXISTING FAILURE ElSHORELINE
*DESIGN FORM(REQUIRED) PI SEPTIC DESIGN(REQUIRED) BEDROOMS o f
3 LOT SIZE 84 r F'l
I l WAIVER(S)(IF APPLICABLE) 0 I I
DIRECTIONS TO SITE AND SITE CONDITIONS(ex locked gale) l`j
from Belfair follow Old Belfair Hwy for 1.5 Miles. Property is on the rt. Test holes are behind I —
the house marked with pink ribbons. 0 r I —
IG
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS I 'J
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT OHOME SALE ❑COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS(CONDITIONS
1\Th '. 0 - '17. k-A(A-S
1-z . b -(0c L wn. S i (S---t- (00 O
r`
P 0(Xe,4 VT \L(q J( 6 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 RNAL APPROVAL
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
6V1,\ t°I ► Iz1) bl 1 ) 2-"4 6(S (z3
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC YEW ON THE MASON COUNTY WEBSITE REVISED 12T7/2015
mom",
DESIGN FORM-PAGE ONE Assessor's Parcel Number. 123201201160- -
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. 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: I I"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG ZQ7.--3-boZAK) Designer's Name: Jim Zimny
MIKE ROBERTS Designer's Phone Number. 360-516-7287
Applicant's Name: P
1540 OLD BELFAIR HWY Designer's Address: 7178 Windflower pL NW
Mailing Address: 1 -
BELFAIR WA 98528 SeabecK Wa 96380
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
'Gravity 0 Pressure rgTrench ❑Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 3034
Daily Flow:Operating Capacity 360 gpd L-I'`;ECM/N) 50 ft
Daily Flow:Design Flow 270 gpd Di l is-ter
O 4 in
Septic Tank Capacity(working) 1200j gal N r�?.erMAY 3 0 2023 3
Receiving Soil Type(1-6) 3 Sep on
ej
9 ctc ft
Receiving Soil Appl.Rate 0.8 gpd/ft2 Orifices
Required Primary Area 450 ft2 Total Number of s NA
Designed Primary Area 450 ft2 Diameter �y in
Designed Reserve Area 450 ft2 Spacing ^ _ �% in
Trench/Bed Width 3 ft // 201 303, coanifold
Jrnef Allen Ilmiry
Trench/Bed Length 150 ' ft M$ED DESIGNER NA
Exams:W17/2, ft
Elevation Measurements Length
Original Drainfield Area Slope 1 % Diameter in
New Slope, If Altered 1 % Preferred manifold configuration used? ❑Yes 0 No
Depth of Excavation up-slope 36 in Transport Pipe
from Original Grade Down_slope 36 in Schedule/Class 3034
Designed Vertical Separation 36 in Length 1 0 ft
Gravelless Chambers Required? 0 Yes 0 No !'Optional Diameter 4 in
Pump Required? 0 Yes Lo1No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day NA
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 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
DESIGN FORM—PAGE TWO Assessor's Parcel Number 123201201160— —
Permit Number SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
ig Test hole locations 0 Drainfield orientation and layout Reference depth from original grade:
V Soil logs 16 Trench/bed dimensions and IFS Septic tank
✓ Property lines critical distances within layout la Drainfield cover
✓ Existing and proposed wells V D-BoxNalve box locations Reference depth from original grade
within 100 ft of property EC Septic tank/pump chamber and restrictive strata:
B Measurements to cuts,banks,and locations El Laterals,trench/bed,top and
surface water and critical areas id Observation port location bottom
H Location and orientation of WI 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:
P1 Location and dimension of V Lateral placement with distance PI Observation ports/clean-outs
primary system and reserve area to edge of bed
Buildings 0Other Information
CI Audible/visual alarm referenced Yes No
✓ Direction of slope indicator P1 Scale of drawing shown on scale 0 0 Design staked out
✓ Waterlines bar 0 0 Recorded Notices attached
Er Roads,easements,driveways, ❑ 0 Waiver(s)attached
parking i ‘ 0 0 Pump curve attached
El North arrow and scale drawing ii,"1„,
❑ ❑ Evaluation of failure
shown on scale bar o Non-residential justification
�� �� � ❑ ❑ Waste strength
ios!N 0 0 Flow
rxr�reg�i n
DESIGN APP VAL
The undersigned designer must be notified by i taller at time of installation e(Yes 0 No
Signature of esi er 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-site regulations:
Environmental Health Spe ialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. c. ( ( 1 ZL-/
✓ 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
4
O
U =
a y� z �p ; 00 � m
i�FI,H � 03iij Lam- A en
Q Yt0 y -1-1 cv
cn U
J �7 QtiI� t/Z Q ' m4* CI d N
127'
W (�
APPROVED
% JUN052023 y
V:,: ki COUN11 ENVIRONMENTAL HEALTH
TS
RE
e1 IA
af
N
a) 13 v
_ E O NO
0 O -11m
� , 4 I „ m NN y
4 ; - > I-- O t—
T.. I
A _
,_ . ,....
...
.....
�'� 0 ��.
_ i- rn �` -`� ----
'��-�— ------..0 �``� /i Co E - �`` ����
13
i�� m `� 0 O/
m O ��
Ali _
' / ' • t O
f / , /
C.
• ``• 1 -Ow / 1
/ > ; 1 1
CD
1 3 ; ••� \ I aCV 1
• \
a, � \ j Q.
— 31
I 1 3 - 3
of /
1 I
` 1° �/
1� 1?i� .` \\ i
•`• AMH Iti../Ia8 PIO `� ;/
•,
4
_ W% �, ' WI
�tty,t r?i ^ 07 o N
-* N
_IoiN ell to a L _ N
„4„, •.,„ g 24 ‘-ti 2 A .z N :3;
I
i
c
1
N
2.
All
1 -aill ° .
N o
X
III
APPROVED
0
o JUN 0 5 2023
.._,
MASON COUNTY ENVIRONMENTAL HEALTH
-a or
RET
CO
O
m
"v
sr
rn
0
ro
1 ,
I.
= 4! Y
i= O , w ,
CU
r ir s
g ;
r.
a.
t I t >
Z
off. t 81 12' � to,
o
it . , ii c "°
L -e i _f_i 1 3
2 at
Iio
tx:
2 i •
z
• U
I
' ' E
}
•
Advantage Perc & Design
Timely-Reasobable-30 Years of Local Experience
Construction Notes for 3 Bedroom Gravity System
Gravity w/graveless chambers(Rock and pipe may be substituted)
Install 3 -50' Laterals.
Use a 4 hole d-box and speed levelers
Install on 9'foot centers. Between existing drainfield laterals
Install 24-36"trench depth on low side of trench and maintain 36"of vertical separation
Install level and along contours.
Install in dry weather only.
Pump Out and certify existing 1200-Gallon septic tank with risers
4
System designed for typical residential waste strength sewage only.
System designed for 360 Gallons Per Day
•��
ar l
•
• �1
APPROVED Jorna:I,nal , �y�,
: LICENSED DESiGNER
JUN 0 5 2023 s ,r, ?,1�
MASON COUNTY ENVIRONMENTAL HEALTH
RET
Advantage Perc&design 411 APDdesigns(aicloud.com (360) 516-7287
rialfmainiliminlim. •
42
r t me _--
_.__
-- .r- . ....
1 III 1 iu II Grow
WIMP
, AMINO
4 U s
,..----)
a1
amaar
NINNIIIIIN•
6,$41: Ii 1200 pion MEM .
I AI
ht
? 2 . `�S+
i O= Jun. ',m7
d i I.ICEN SED OtSiGNER
Expiron:W17/Z'
8
APPROVE®
•
JUN 05 20R3
MASON,Ittbn ENVIROH ENZAL NEAUrt
RET