HomeMy WebLinkAboutSWG2023-00184 - SWG Application / Design - 5/11/2023 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:360482-5269, EXT400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00184
APPLICANT Brand, Andy Phone:
Address: 2120 W Cloquallum Rd SHELTON, WA 98584
OWNER Brand, Andy Phone:
Address: 2120 W Cloquallum Rd SHELTON, WA 98584
SEPTIC DESIGNER DALE TAHJA- Septic Designer Phone: 360-426-5940
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: 2129 W Cloquallum Rd
Primary Parcel Number: 420361400080
Permit Description: 4-bedroom gravity system
Permit Submitted Date: 05/11/2023
Permit Issued Date: 06/12/2023
Issued By: David Anderson
Current Permit Fees Paid: $780.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/23/2026 (based on date of inspection)
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department staff per Mason County Title 17.
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
3 Drain field installation not to exceed designed upslope and downslope depth specified on
design form.
4 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
5 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
6 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.gov/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
176:1.
OFFICIAL USE ONLY
•
MASON COUNTY DATE RECEIVED
..0417- COMMUNITY SERVICES A RECEIVED:= RECE EDGY: '1 o m
Public Health(Community Health/Environmental Health) Z N
415 N.6t Street
ext.400ttn,WA 9 584 ext.400 S W G �;� -� - co k y z Cl)
415 N.6th$Meet-Shelton.WA 98564
ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT PHONE r
Andy Brand (360) 490-9474 c
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE E
2120 W. Cloquallum Rd. Shelton WA 98584 m
SITE ADDRESS-STREET,CITY,ZIP CODE
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2129 W. Cloquallum Rd. 0 Shelton WA 98584 -1'
NAME OF DESIGNER L PHONE
Dale Tahja �' MAY 1 1 2023 N
(360) 426-5940
NAME OF INSTALLER BY: PHONE ID CD
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PERMIT;; TYPE(select one) DRINKING; WATER SOURCE N I W
ICL+RESIDENTIAL OSS 'COMMUNITY OSS I�COMMERCIAL OSS t1Gl W PRIVATE INDIVIDUAL WELL 5 PRIVATE TWO-PARTY WELL Z I
TYPE OF WORK(select one) D;PUBLIC WATER SYSTEM
I
WI;NEW CONSTRUCTION/UPGRADES b REPAIR 1 REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE IX REPAIR I
SUBMIT,TALS
W ❑ SURFACING SEWAGE 0 EXISTING FAILURE El SHORELINE
DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE 0 I �'
IWAIVER(S)(IF APPLICABLE) 4 2.5 acres 0 I 10
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex.locked gate)
Leave Shelton south on Cloquallum Rd., property 2.1 miles on the right. Chainsaw sticking ( I o
out of be rock as you enter driveway. Proceed past house and shed, property is second lot r I o
from road, Andy ownes both lots. Drainfield area in middle of christmas tree area.
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SITE MUST SE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED MTH TEST HOLE NUMBERS. I Co
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(tor reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT El HOME SALE OCOMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
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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 FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
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THIS FORM 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 0 3 6 — 1 4 — 0 0 0 8 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. 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 IDE1 'f L A'TION
Permit Number: SWG _ Designer's Name: Dale Tahja
Applicant's Name: Andy Brand _ Designer's Phone Number: 3604265940
Mailing Address: 2120 W. Cloquallum Rd. Designer's Address: 2450 W Deegan Rd W
Shelton WA 98584 Shelton WA 98584
Cit. r State Zip City State Zip
D> S) I rARAMETER$ ,
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
l 'Gravity 0 Pressure gTrench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
/
Number of Bedrooms 4 (/ Schedule/Class 3034
Daily Flow:Operating Capacity 360 gpd V Length 67 ft
Daily Flow:Design Flow 480 gpd Diameter 4 in
Septic Tank Capacity(working) 1,250 g� Number 4
Receiving Soil Type(1-6) 4 ✓ ft
,/Separation 6-9
Receiving Soil Appl.Rate 0.6 gpd/ftt/ Orifices
Required Primary Area 800 ft2 k/ Total Number of Orifices perf. pipe
Designed Primary Area 800 ft2 Diameter in
Designed Reserve Area 800 ft2 Spacing in
Trench/Bed Width 3 ftV% Manifold
Trench/Bed Length 268 ft V Schedule/Class 3034
Elevation Measurements / Length 44 ft
Original Drainfield Area Slope 4 % ' Diameter 4 in
New Slope,If Altered 4 % Preferred manifold configuration used? 0 Yes 6g No
Depth of Excavation Up-slope 24 in Transport Pipe
from Original Grade Down-slope 22 in Schedule/Class 3034
Designed Vertical Separation 24 in Length 10 ft
Gravelless Chambers Required? 0 Yes 0 No g Optional Diameter 4 in
Pump Required? 0 Yes 0 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 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head Gravity gpm ❑Timer DElapse Meter 0 Event Counter
Calculated Total Pressure Head ft If Timer: Pump on A PP i'4 c F 1)
Comments
JUN 1 2 2023
McC041-C844A*EN•ViRONMENTAt WCAL;r
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DESIGN FORM—PAGE TWO Assessor's Parcel Number:4 2 0 3 6 — 1 4 -- 0 0 0 8 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Fii Test hole locations 6t Drainfield orientation and layout Reference depth from original grade:
It Soil logs Et Trench/bed dimensions and 16 Septic tank
6i Property lines critical distances within layout Q( Drainfield cover
rg Existingand proposed wells 6t D-Box/Valve box locations
P P Reference depth from original grade
within 100 ft of property Et Septic tank/pump chamber and restrictive strata:
0 Measurements to cuts, banks,and locations
Igf Laterals,trench/bed,top and
surface water and critical areas 66 Observation port location bottom
6t Location and orientation of 171 Clean-out location 0 Curtain drain collector
curtain drain and all absorption 131 Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
g Location and dimension of Eid Lateral placement with distance It Observation ports/clean-outs
primary system and reserve area to edge of bed
0 Buildings Other Information
0 Audible/visual alarm referenced Yes No
01 Direction of slope indicator Eti Scale of drawing shown on scale El 0 Design staked out
6t Waterlines bar 0 0 Recorded Notices attached
Ft Roads,easements,driveways, 1t 0 Waiver(s)attached
parking 0 0 Pump curve attached
It 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 must be notified in le t time of installation Et Yes 0 No
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ignature of Designer Date `40%0 •: O
The undersigned has reviewed this design on behalf of Mason County Public Health and dete .,f , L in<.1$.�
co tk it tic> local on- � egulations: a•� 'c, ••0 v ;,w
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11 nvironmental Health Specialist Date`1� ,, ,I "', -„ ._, `•
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CAM ON: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CO :t1 '$ , r - ,�++
MASC'l OU i eLdesign is stamped"Approved" by Mason County Public Health. !r:
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: N� (). 1'.I
✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval. l i ,
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
Gravity 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. Divert all storm water run-off away from septic system components.
4. No curtain (french) drains allowed within l 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.
APPROVED
JUN 1 2 2023
fit, MASON COUNTY ENVIRONMENTAL HEALTF'
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