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HomeMy WebLinkAboutSWG2023-00257 - SWG Application / Design - 6/14/2023 M . MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360427-9670,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: SWG2023-00257 APPLICANT GOULD DOUGLAS LEE&ROBIN LEE Phone: Address: 841 EAST CAMDEN WAY SHELTON, WA 98584 OWNER GOULD DOUGLAS LEE& ROBIN LEE Phone: Address: 841 EAST CAMDEN WAY SHELTON,WA 98584 SEPTIC DESIGNER MICAH HALVERSON-M. Halverson Phone: 360-490-6365 Design LLC Address: PO BOX 1519 SHELTON,WA 98584 Site Address: 843 E Camden Way Primary Parcel Number: 120311290050 Permit Description: New SFR-3BR Gravity Permit Submitted Date: 06/20/2023 Permit Issued Date: 07/05/2023 Issued By: Jeff Wilmoth Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system). Permit Expiration Date: 07/05/2026 (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/onsite/oss-inspection-request.php or call: 360-427-9670, extension 400. -0... - OFFICIAL USE ONLY MASON COUNTY DATE RECEIVED: - 1 - .I I. COMMUNITY SERVICES AMOUN VED RECEIVE Y: / cn co cD m Public Health (Community Health/Environmental Health) d C cn N ext.40e a 7,en.400 415 N 6th Street•Shelton,WA 98584 S W G Q 6 23 — W -1_6 1- 00 Z cn ON-SITE SEWAGE SYSTEM APPLICATION g m n APPLICANT PHONE m Doug & Robin Gould 360-463-6540 ,A z MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE T E 841 E Camden Way Shelton Wa 98584 r: SITE ADDRESS-STREET,CITY,ZIP CODE 843 E Camden Way Shelton Wa 98584 0 (— NAME OF DESIGNER PHONE Micah Halverson 360-490-6365 IN NAME OF INSTALLER PHONE 0 I Logan Spear 360-239-1541 R PERMIT TYPE(select one) DRINKING WATER SOURCE � y-tl O IV( RESIDENTIAL OSS ri COMMUNITY OSS l COMMERCIAL OSS rl PRIVATE INDIVIDUAL WELL LT PRIVATE TWO-PARTY WELL Z I— TYPE OF WORK(select ono) ❑ PUBLIC WATER SYSTEM I 1 NEW CONSTRUCTION/UPGRADES rl REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I--_ SUBMITTALS 0 SURFACING SEWAGE El EXISTING FAILURE 0 SHORELINE W Fir DESIGN FORM(REQUIRED) ..'SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE or- IN _ h WAIVER(S)(IF APPLICABLE) 3 1 .26Ac a ' DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) After Harstine Island Bridge turn right (south), at stop sign turn right again continuing south, to turn left on E Camden Way. Contact Designer or Applicant for Gate code to enter Camden r- Way. Perk holes are marked with pink ribbon drainfield is staked out o I� I&) SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I OFFICIAL USE ONLY BELOW THIS LINE — UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS (--/ (.6 /' 0 m 5 .--)--forvs_. --4---d 71/1(e)-- y (;) / 3 RA: 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 FINAL APPROVAL. PECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE LIGATION APPROVED/ISSUED BY DATE LlAr".0\-'1I/-\ u; 23 T IS F M MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12f712015 DESIGN FORM—PAGE ONE Assessor's Parcel Number: i 2 d 3 i -- 1 2- -- 1 O ©� O A design will be reviewed when 3 copies of each of the following are submitted: Y Completed design form that has been signed and dated. Scaled layout sketch,including all applicable items on checklist Y Scaled plot plan,including all applicable items on checklist. Y 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 0�3 - 60;2 S? Designer's Name: Micah Halverson Permit Number: SWG `� s= g Applicant's Name: Doug&Robin Gould Designer's Phone Number: 360-490-6365 Mailing Address: 841 E Camden Way Designer's Address: PO Box 1519 Shelton Wa 98584 Shelton Wa 98584 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: Septic Tank Drainfield Type El'Gravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 3 Schedule/Class ASTM 2729 Daily Flow: Operating Capacity 360 gpd Length 50 ft Daily Flow:Design Flow 360 gpd Diameter 4 in Septic Tank Capacity(working) 1200 gal Number 3 Receiving Soil Type(1-6) 3 Separation 9 ft Receiving Soil Appl.Rate 0.8 gpolftZ Orifices Required Primary Area 450 ft2 Total Number of Orifices Perf. 4 Designed Primary Area 450 ft2 Diameter in Designed Reserve Area 450 ft2 Spacing in Trench/Bed Width 3 ft Manifold I Trench/Bed Length 150 ft Schedule/Class D-Box ft Elevation Measurements Length 1 Original Drainfield Area Slope 4-5 0/0Diameter in New Slope,If Altered same % Preferred manifold configuration used? 0 Yes 0 No Depth of Excavation Up-slope 14 in Transport Pipe from Original Grade Down-slope 12.2 in Schedule/Class ASTM 3034 Designed Vertical Separation 36+ in Length 5 ft Gravelless Chambers Required? 0 Yes ef No 0 Optional Diameter 4 in Pump Required? 0 Yes ITC No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day Gravity Diff. in Elevation Between Pump&Uppermost Orifice N/A ft Dose quantity N/A gal Drainfield Squirt Height/Selected Residual(head) N/A ft Chamber Capacity(flood) N/A gal Pump controls:Please check those required. Uppermost Orifice El Higher 0 Lower than Pump Shutoff • la•se Meter ❑Event Counter Capacity @ Total Pressure Head N/A gpm OTimer Calculated Total Pressure Head N/A ft If Timer: Pump on , t' . 1. 'Oplif /A Comments JUL 0 5 2023 t61ASoN COUNTY ENVIRONMENTAL HFAI Th JBW DESIGN FORM—PAGE TWO Assessor's Parcel Number: fL6 3 1 -- r 2 -- 9 eo50 Permit Number: SWG DESIGN CHECKLISTS Y Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch 0 Test hole locations Q Drainfield orientation and layout Reference depth from original grade: ! Soil logs g Trench/bed dimensions and Lot Septic tank H Property lines critical distances within layout 63 Drainfield cover V Existing and proposed wells g D-BoxNalve box locations Reference depth from original grade within 100 ft of property L( Septic tank/pump chamber and restrictive strata: 0 Measurements to cuts,banks, and locations 0' Laterals,trench/bed,top and surface water and critical areas V Observation port location bottom O Location and orientation of V Clean-out location 0 Curtain ollector curtain drain and all absorption 0 Sand a ion iP lg Manifold placement components V Orifice placement Other cross-section detail: O Location and dimension of Lot Observation ports/clean-outs !g Lateral placement with distance primary system and reserve area to edge of bed Other Information 0 Buildings 0 Audible/visual k referenced Yes No H Direction of slope indicator V Scale of drawing shown on scale Lo' 0 Design staked out E1 Waterlines bar 0 g Recorded Notices attached P Waiver(s) attached V Roads, easements,driveways, ❑ 1$Pump curve attached parking V Evaluation of failure V North arrow and scale drawing JUL 0 5 2023 shown on scale bar A Non-residential justification ,MASON COUNTY ENVIRONMENTAL HEALTH ❑ Waste strength JBW 0 Lot Flow DESIGN APPROVAL The undersigned designer must be Y tified by installer at time of installation El Yes 0 No / LASIt0 L3 Signature of Designer 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 ite regulations: L1 / (, v� 7,3_ �� E vir;iis.en 1 Health 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: (ij - z6 -, ✓ Drainfield site conditions have not been altered to adversely feet conditions of design approval. Please Note: The system must be insta led 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 oh the Mason County Web site.I dated Date: 12/7/2015 I ,r E 3 132' +/- a) q CD a . = 0 0 =_3 w p E .gig .. �a.g �g��(�WCJiCn rt : . 8' v I a_3 5 N8 -n WI _ I cn O O A— . I1.t :tab. n —IX 8 6 Op 5 1 g .3 :71 ; NaL I �cn� a -` ►— ' c m L ^'Q '-'�cnco s.� � cn o I m o C CO I a dj coCo LI„� I / 3. r m � il 11:31 " • I - • r i� I ID Ma etz_y L. ATAT , \k. % v� U� - 0 0 If!k U;,,v.:vit 4-.1‘' ---i16- 0 Z �� I r - - I s-AN ' -0 r I $ , ."• I o - I 0 22 so N ii 9 I 1 °' Q 8 p i I F8a8�38ff S'Pgq_ g°'= L N - - l '� v I D`< a. o -3 .. 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