HomeMy WebLinkAboutSWG2023-00161 - 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,EXT400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00161
APPLICANT TUPPER STEVE &JESSICA Phone:
Address: 343 W LAKE NAHWATZEL DR SHELTON, WA 98584
OWNER TUPPER STEVE &JESSICA Phone:
Address: 343 W LAKE NAHWATZEL DR SHELTON, WA 98584
SEPTIC DESIGNER DALE TAHJA-Septic Designer Phone: 360-426-5940
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: 343 W Lake Nahwatzel Dr
Primary Parcel Number: 520082200330
Permit Description: New SFR 3BR Gravity w/class b waiver
Permit Submitted Date: 05/01/2023
Permit Issued Date: 05/31/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $780.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/02/2026 (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: ma soncountywa.gov/health/environmental/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
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- OFFICIAL USE ONLY 0....,0_,
DATE RECEIVE6
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ON-SITE SEWAGE SYSTEM APPLICATION 3
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APPLICANT PHONE m
Steve Tupper (360) 359-1633 c
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 3
343 W. Lake Nahwatzel Dr. Shelton WA 98584 m
SITE ADDRESS-STREET,CITY,ZIP CODE U7)--e\ton
343 W. Lake Nahwatzel Dr. T (� 11 i ` WA 98584 1t'D -
NAME OF DESIGNER PH
Dale L. Tahja MAY 01 2023ONE 0) 426-5940 N
NAME OF INSTALLER PHON I O
PERMIT TYPE(select one) (� y DRINKING WATER SOURCE �
glRESIDENTIAL OSS COMMUNITY OSS x.(COMMERCIAL OSS b5 PRIVATE INDIVIDUAL WELL qt7. PRIVATE TWO-PARTY WELL 'Z I co
TYPE OF WORK(seed one) crj PUBLIC WATER SYSTEM ,
gi NEW CONSTRUCTION/UPGRADES (REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I fV
SUBMITTALS ((�� 0 SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINE
CO
Eir DESIGN FORM(REQUIRED) iifiSEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r I N
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fif.WAIVER(S)(IF APPLICABLE) 3 6.9 acres '
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex.locked gate) I O
Head west on the Shelton/Matlock Rd., turn right onto Lake Nahwatzel Dr., property on the I I c)
left. o I w
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED KITH TEST HOLE NUMBERS. I O
- - OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT 0 OTHER: 1
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
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SOIL CODES: RECORD DRAWING AND INSTALLATION RE'0.2.\`
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
1 CTOR SIGNATURE ,._,,-2-3
DATE APPLICATION EXPIRATION DATE APP (CATION APPROVED/ISSUED BY DATE
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IS MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 1217/1015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 5 2 0 0 8 — 2 2 — 0 0 3 3 0
A design will be reviewed when 3 copies of each of the following are submitted:
'1 Completed design form that has been signed and dated. '1 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. %laximum aper size: 11"X 17" .
PARCEL IDENTIFICATION
Permit Number: SWG O2.1D - 0 D\6\ Designer's Name: Dale Tahja
Applicant's Name: Steve Tupper Designer's Phone Number: (360)426 5940
Mailing Address: 343 W.Lake Nahwatzel Dr. Designer's Address: 2450 W Deegan Rd W
Shelton WA 98584 Shelton WA 98584
City State Zip City State Zip
DESIGN.:fARAM.ETERS
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: N/A
Drainfield Type
licGravity 0 Pressure G 'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 3034
Daily Flow:Operating Capacity 270 gpd Length 67 ft
Daily Flow:Design Flow 360 gpd Diameter 4 in
0 Septic Tank Capacity(working) 1,200 gal Number 3
Receiving Soil Type(1-6) 4 Separation 6 ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 600 ft2 Total Number of Orifices Perf. Pipe
Designed Primary Area 600 ft2 Diameter in
Designed Reserve Area 600 ft2 Spacing in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 200 ft Schedule/Class 3034
Elevation Measurements Length 20 ft
Original Drainfield Area Slope 6 % Diameter 4 in
New Slope,If Altered 5 % Preferred manifold configuration used? 0 Yes 6 'No
Depth of Excavation Up-slope 14 in Transport Pipe
from Original Grade Do -slope 12 in Schedule/Class 3034
Designed Vertical Separation 18 in Length 60 ft
Gravelless Chambers Required? 0 Yes 0 No el Optional Diameter 4 in
Pump Required? ❑Yes It No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day Gravity
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 ElLower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head gpm e>p R OlVe • ,,. • 0 Event Counter
Calculated Total Pressure Head ft If Ti ump on , ' `:' -
Comments MAY 3 U 2023 4,:
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 5 2 0 0 8 — 2 2 -- 0 0 3 3 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Fiti Test hole locations g Drainfield orientation and layout Reference depth from original grade:
0 Soil logs g Trench/bed dimensions and g Septic tank
0 Property lines critical distances within layout 21 Drainfield cover
Existing and proposed wells g D-Box/Vaive box locations Reference depth from original grade
within 100 ft of property gr1 Septic tank/pump chamber and restrictive strata:
g Measurements to cuts, banks, and locations
gl Laterals,trench/bed,top and
surface water and critical areas g Observation port location bottom
Ezt Location and orientation of g Clean-out location 0 Curtain drain collector
curtain drain and all absorption fili Manifold placement 0 Sand augmentation
components
66 Orifice placement Other cross-section detail:
0 Location and dimension of g Lateral placement with distance g Observation ports/clean-outs
primary system and reserve area to edge of bed
!� Buildings Other Information
0 Audible/visual alarm referenced Yes No
gl Direction of slope indicator g Scale of drawing shown on scale af ❑ Design staked out
fil Waterlines bar 0 0 Recorded Notices attached
O Roads,easements,driveways, g 0 Waiver(s)attached
parking 0 0 Pump curve attached
0 North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑ Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer mtsistl7tified b instal t time of installation fiti Yes 0 No
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Signature of Designer Date ref` ; ,
The undersigned has reviewed this design on behalf of Mason County Public Health and dete ' 44t in .
compliance with state and local on-site lations: � C,o U a,N✓c,t
Envi r , ' Health Specialist Date �1�;b*.gc,�3p„ ;.
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CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CON IE%.i � w
✓ The design is stamped"Approved"by Mason County Public Health. r `1cik '' '�
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: S. 1 Q r
✓ 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 obtain from Mason County Public Health.
PPROVE
An Installation Fee is required. MAY 3 4 3
This form may be scanned and available for public- aiata ha Mason eb site.
Y ENVIRONMENTAL HEALTH Updated Date: 12/7/2015
JBW
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Installation/Maintenance
Gravity Distribution/Trench Systems
I. 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. Divert all storm water run-off away from septic system components.
4. No curtain(french) drains allowed within I Oft. of the up-slope edge of the drainfield and
reserve area.
5. No curtain (french) drains allowed within 30ft. of the down-slope edge of the drainfield
and reserve area.
6. Have the septic tank pumped or inspected every 3 to 5 years.
7. All material and workmanship must meet County and State requirements.
8. Install risers on septic tank.
9. Deviation from this approved design without prior approval from the Designer and
Mason County Health Department will make this design null and void.
10.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.
11.Locate all utilities prior to starting installation.
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