HomeMy WebLinkAboutSWG2023-00185 - SWG Application / Design - 5/12/2023 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: SWG2023-00185
APPLICANT MARC & BARBARA GITLIN Phone:
Address: 3459 W MARDAD DR LAKE ZURICH, IL 60047
SEWAGE DESIGNER Jim Zimny -Advantage Perc & Design Phone: 360-516-7287
Address: 7178 WINDFLOWER PL NW SEABECK, WA 98380
Site Address: UNKNOWN
Primary Parcel Number: 123194250030
Permit Description: New 3bd gravity trench with class b waiver
Permit Submitted Date: 05/12/2023
Permit Issued Date: 05/30/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/19/2026 (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.
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VMOOFFICIAL USE ONLY ClMASON CO "c - ID , X 3 1 c t;
in0 COMMUNITY.SERVICES __ AMOUNT RECEIVED: RECEIVED
Pub&Healfh(Community HealthAnvironmental Health) r (n
360-427-9670,ext.400 a 360-275-446?,ex t..WON O
415 N 6Th o'Street-SheR .WA 43584 SVG - 3(2)L<5 p3
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ci FAR FORM ON-SITE SEWAGE SYSTEM APPLICATION zxi
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APPLICANT PHONE m
Marc & Barbara Gitlin z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE g
3459 W Mardad Dr, Long Grove IL 60047 m
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SITE ADDRESS-STREET,CITY,ZIP CODE
Ridgetop Ct, Belfair WA 98528 I--
NAME OF DESIGNER PHONE
Jim Zimny 360-516-7287
NAME OF INSTALLER PHONE v
I
PERMIT TYPE(sek DRINKING WATER SOURCE T
ctone) _ Q
COMMERCIALW RESIDENTIAL OSS f COMMUNITY OSS OSS � PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z I^'
TYPE OF WURK(sekect one) Q PUBLIC WATER SYSTEM t
WNEW CONSTRUCTION/UPGRADES rl REPAIR t REPLACEMENT OTHER DETAILS(select all Mal apply) 0 TABLE IX REPAIR I
SUBMITTALS 0 SURFACING SEVWGE 0 EXISTING FAILURE El SHORELINE co I
DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS 3 LOT SIZE cv
5 Acres O i
W WAIVER(S)(IF APPLICABLE) n
DIRECTIONS TO SITE AND SITE CONDITIONS(ex corked gate) v\
from Belfair go .9 Miles to sand hill Rd and take RT. Go 1.5 miles to Ridge Top Ct . Take rt. I O
Follow to the end of the street and lot is on The Left. Marked w/ Pink Ribbons. r
Follow marked ribbons to Test holes on North side of lot. o I D
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS I I )
OFFICIAL USE ONLY BELOW THIS LINE ��/l
0 UPGRADE I FAILURE SOURCE(tor reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ['COMPLAINT 0 OTHER:
INSPECTOR SOIL LOGS COMMENTS 1 CONDITIONS
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111\2 :
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3 1 St-
RECORD DRAVVING 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
IN CTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/DIED BY DATE
' 1140 Ian i Lect )-2_& CA-will s'iryi 3/i-747 -z-,
THIS FORM MAY BE SCANNED
ANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2O15
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DESIGN FORM—PAGE ONE Assessor's Parcel Number. 123194250030- —
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 IDENTIFICATION
Permit Number: SWG 2D j' ' 00► 5 Designer's Name: Jim Zimny
Applicant's Name: Marc Barbara Gitlin Designer's Phone Number. 360'516 7287
Mailing Address: 3459 W Mardad Dr Designer's Address: 7178 Windflower PI NW
Long Grove IL 60047 SDeabeck WA 98380
CLEAR FORM
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device
❑Glcndon Biofiltcr 0 Sand Filter 0 Mound 0 Sand Lined Ihninficld ❑Recirculating Filter,Type:
❑Aerobic Unit Make/Model i 0 Disinfection Unit Make/Model Other:
1
Drainfield Type
L'Gravity 0 Pressure !'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 ; Schedule/Class 3034
Daily Flow:Operating Capacity 360 gpd Length 50 ft
Daily Flow: Design Flow 270 gpd Dieter 4 in
Septic Tank Capacity(working) 1200' gal Number 4
Receiving Soil Type(1-6) 4 Separation �� 5 ft
Receiving Soil Appl.Rate 0.6 1 gpd/ft2 .. it
ti Orifices
Required Primary Area 600 ft2 Total N; .r F�4:_1V�.?.s NA
` ��> 411l NA
Designed Primary Area 600 , ft2 D-• ii;'. l , ,— t in
Designed Reserve Area 6001 ft2 Spa•:,gyp r. NA in
Express:8/19/
Trench/Bed Width 3 ft 2� Manifold
Trench/Bed Length 200 ft Schedule/Class NA
Elevation Measurements Length NA ft
Original Drainfield Area Slope 5 . % Diameter NA in
i
New Slope,If Altered 5 % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation uP-Slope 121 in Transport Pipe
from Original Grade Down-slope 10 in Schedule/Class 3034
Designed Vertical Separation 18 j in Length 85 ft
Gravelless Chambers Required? 0 Yes 0 No l'Optional Diameter 4 in
Pump Required? ❑Yes P'No 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 Pump controls:Please check those required.
Capacity @ Total Pressure Head gpm Minter ❑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 123194250030— —
Permit Number SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
E1 Test hole locations 0 Drainfield orientation and layout Reference depth from original grade:
!l1 Soil logs 0 Trench/bed dimensions and Er Septic tank
O Property lines critical distances within layout IF Drainfield cover
O Existing and proposed wells l D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 0 Septic tank/pump chamber and restrictive strata:
l Measurements to cuts, banks,and locations B Laterals,trench/bed,top and
surface water and critical areas V Observation port location bottom
0 Location and orientation of Er Clean-out location 0 Curtain drain collector
curtain drain and all absorption 0 Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
Er Location and dimension of RI Lateral placement with distance F Observation ports/clean-outs
primary system and reserve area to edge of bed
It Buildings g Other Information
ElAudible/visual alarm referenced Yes No
Ef Direction of slope indicator Er Scale of drawing sho on scale 0 Er Design staked out
4 l� Waterlines ; bar ;'++ Er 0 Recorded Notices attached
Er Roads,easements,driveways, I f- '• ` 0 0 Waiver(s) attached
parking i 4�+ ❑ 0 Pump curve attached
+ 0 0 Evaluation of failure
O North arrow and scale drawing j s, N.
��
shown on scale bar
h :7 ..3 �++ Non-residential justification
L.IIE 1 c,[)ESIGNER w A 0 0 Waste strength
I Eapirsc&I 23 ❑ ❑ Flow
ESIGN APPROVAL
1 The undersigned designer must be notifie staller time of installation Er Yes 0 No
S.- /- 2 3
Signature o signer 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:
S3o (a-
Environmental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health.
O The Onsite Sewage Permit has not expired,the Permit Expiration Date is: c-ilcr 1-'
✓ 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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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)
Install13-50' Laterals .
Use a 6 hole d-hox and speed levelers
Install on 5'foot centers.
Install 9-10"trench depth on low side of trench and maintain 18" of vertical separation
Install level and along contours.
Install in dry weather only.
Use 1200-Gallon septic and add rises for pumping and maintenance
System designed for typical residential waste strength sewage only.
System designed for 360 Gallons Per Day
APPROVED
MAY 3 0 2023
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