HomeMy WebLinkAboutSWG2023-00244 - SWG As-Built - 6/13/2023 6"14,1 : MASON COUNTY415 N 6TH STREET,SHELT ,E 400
98SHELTON:360 427-9679670 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: SWG2023-00244
APPLICANT Michael Sprouffske Phone:
Address: 27584 Anchor PI NW POULSBO, WA 98370
SEPTIC DESIGNER PAULA JOHNSON -Arrow Septic Phone: 360-898-2255
Designs Inc.
Address: 171 E VUECREST DRIVE UNION, WA 98592
Site Address: 240 E Klondike Trail
Primary Parcel Number: 120187500010
Permit Description: New SFR -3BR Gravity
Permit Submitted Date: 06/13/2023
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: 06/26/2026 (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.
OFFICIAL USE ONLY
DATE RECENED: r �I
MASON COUNTY \ J c u)
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Public Health(Community Health/Environmental Heath;
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ON-SITE SEWAGE SYSTEM APPLICATION D
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APR_CAN'
Michael Sprouffske, Sr. (360)633-1804 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE E
27584 Anchor PI NW Poulsbo WA 98370 co
SITE ADDRESS-STREET.CITY,ZIP CODE
240 E Klondike Trail Shelton WA 98584 I
NAME OF DESIGNER PHONE I N
Arrow Septic Designs (360)898-2255
NAME OF INSTALLER PHONE 0 I C)
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PERMITQ TYPE(select one) DRINKING WATER SOURCE
5
liK RESIDENTIAL OSS ]COMMUNITY OSS IBCOMMERCIAL OSS ®�PRIVATE INDIVIDUAL WELL EPRIVATE TWO-PARTY WELL Z I co
TYPE OF NARK(sabot one ill PUBLIC WATER SYSTEM ,
)NEW CONSTRUCTION/UPGRADES fiI REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑TABLE IX REPAIR I
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE ElSHORELINE
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DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS 3 BR LOT SIZE
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WAIVER(S)(IF APPLICABLE) 5 acres Z ,
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DIRECTIONS TO SITE AND SITE CONDITIONS'(er,locked gate)
**Use 621 E Island Shores Rd in GPS** I o
Go out Hwy 3 and turn right onto E Pickering Rd toward Park&Ride. Keep right onto E Pickering Rd. r-
Turn left onto E Harstine Bridge Rd.Turn right onto E South Island Dr. Turn left onto E South Island Dr. Sio
Continue on E South Island Dr.Turn right onto E Harstine Island Rd S. Turn left onto E Island Shores
Rd. Blue Klondike Trails sign on (L). Go to end -Lot on (R). Yellow sign: "240 E Klondike Trail"
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I O
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE ❑COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS I COMMENTS I CONDITIONS
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, Puri � 3 2023
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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
S C R SIGNATURE DATE APPLICATION EXPIRATION DATE A LI TIO APPROVED/ISSUED BY DATE
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T IS M MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE 3
REVISED 12/712O 5
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 1 2 0 1 8 — 7 5 — 0 0 0 1 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. 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"
.,
;PARCEt IDENTIFICATION ;'
Permit Number: SWG ;i-- s' Designer's Name: Arrow Septic Designs
Applicant's Name: Michael Sprottffske Designer's Phone Number: (360)898-225
Mailing Address: 27584 Anchor PI NW Designer's Address: 171 E Vuecrest Dr
Poulsbo WA 98370 Union WA 98592
City State Zip City State Zip
M.411;.%%:: . , DESIGN PARAMETERS
Treatment Device
❑Glendon Biofilter ❑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 !if Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 2729
Daily Flow:Operating Capacity 270 gpd Length 38 ft
Daily Flow:Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity(working) 1,200 gal Number 4
Receiving Soil Type(1-6) 3 Separation 9 ft
Receiving Soil Appl.Rate 0.8 gpd/ft` Orifices
Required Primary Area 450 ft2 Total Number of Orifices —
Designed Primary Area 456 ft2 Diameter — in
0 Designed Reserve Area 456 ft2 Spacing — in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 152 ft Schedule/Class —
Elevation Measurements Length — ft
Original Drainfield Area Slope 3 % Diameter -- in
New Slope,If Altered 3 % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slope 28 in Transport Pipe
from Original Grade Down-slope 27 in Schedule/Class 3034
Designed Vertical Separation 36+ in Length 20 ft
Gravelless Chambers Required? 0 Yes Ed No ❑Optional Diameter 4 in
Pump Required? 0 Yes lifNo Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day —
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 ❑Timer ❑Elapse Meter 0 Event Counter
Calculated Total Pressure Head — ft If Timer: Pump on — ,Pump off —
Comments
APPROVE z
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V MASON-COUNTY ENVIRONMENTAL HEALTH
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DESIGN FORM—PAGE TWO Assessor's Parcel Number: 1 2 0 1 8 — 7 5 -- 0 0 0 1 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
wl Test hole locations lid Drainfield orientation and layout Reference depth from original grade:
Ig Soil logs Ftf Trench/bed dimensions and E Septic tank
Pi Property lines critical distances within layout Ef Drainfield cover
Iii D-Box[Valve box locations
Ed Existing and proposed wells Reference depth from original grade
within 100 ft of property lii Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts,banks,and locations Ed Laterals,trench/bed,top and
surface water and critical areas Elf Observation port location bottom
❑ Location and orientation of 0 Clean-out location 0 Curtain drain collector
curtain drain and all absorption 0 Manifold placement 0 Sand augmentation
components ❑ Orifice placement Other cross-section detail:
Location and dimension of g Lateral placement with distance if Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
lili Buildings ❑ Audible/vis referenced Yes No
Ed Direction of slope indicator Ig Scale of dr wn on scale g in Design staked out
fZi Waterlines bar 0 lif Recorded Notices attached
f l Roads,easements,driveways, o� ��+ 0 El Waivers)attached
parking .�;! • • 0 l�Pump curve attached
Ed North arrow and scale drawing �_ II �t '•.,��
❑ Cif Evaluation of failure
shown on scale bar -L- , 516 9 Non-residential justification
is P.AULA JOY JOHNSON';•1I ❑ g Waste strength
5==: 5161 o-k-5? i rf. -0 56 Flow
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DESIGN APPROVAL
The undersigned designer must be Tied by i tall at time of installation El Yes 0 No
(0-( 2-23
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 o i e regulations:
En ro Fig tal Health Specialist Date
CAUTION: DESIGN APPR VAL 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: 6 2 a -2.
✓ 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.
4
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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SECURED LID WITH GAS TIGHT SEAL
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SEDIMENTS
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**Note: Septic Tanks must meet standards required by WAC chapter 246-272C
and manufacturer must be on the Dept of Health list of registered sewage tanks. **
Cl�xauc Septic Deesigno .
INSTALLATION& MAINTENANCE gr
Gravity Distribution Systems 5100a49 • ''I
uZ PAULA JOY JOHNSON'5 I�
1. Install Laterals with contour of the ground. -Ltdbpi Vim•},
exru+Es
2. Install trench bottoms level.
3. Install locator tape or rebar at each end of all drainfield laterals.
4. Install observation ports as indicated on the detailed drainfield layout. One required at
distal end of each lateral in drainfield with bottom extending to the drainrock/native soil
interface. Glue "T"to bottom so Observation Port cannot be easily removed from
ground. Install removable cap on top of port at final grade level.
5. Install drainfield during dry weather and soil conditions; any soil smearing must be
eliminated by hand raking.
6. Use distribution box with speed levelers and cover to surface. Divert incoming pipe
down with 90-degree angle to prevent short-circuiting.
7. Filter fabric required over drain rock prior to back filling. If the drain rock extends above
natural grade, run the filter fabric at least 2 inches down the trench wall.
8. Encase all water lines within 10' of drainfield and under any driveway/parking areas.
9. Divert all storm water runoff away from on-site sewage system.
10. No curtain drains allowed within 10' of the up-slope edge or 30' of the down-slope edge
of the drainfield and reserve area.
11. No vehicular traffic over drainfield area.
12. Install Bio-Tube or equivalent effluent filter at outlet end of septic tank.
13. All manhole lids and access, sampling or inspection ports must have locking covers and
be located at ground level.
14. Inspect tank and clean filters every 6-12 months as needed.
15. Have the septic tank pumped or professionally inspected every 3 to 5 years.
16. All materials and workmanship must meet County and State regulations.
17. Deviation from this design without prior approval from the Designer and Mason County
Environmental Health Department will make this design null and void.
• 18. All transport lines under driveways or parking areas must be encased to prevent crushing.
1 19. Homeowner is responsible for all property lines.
APPROVE
JUL 0 5 2023
MASON COUNTY ENVIRONMENTAL HEALTy
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