HomeMy WebLinkAboutSWG2023-00222 - SWG As-Built - 6/5/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
t Public Health & Human Services ELMA:360-482-5269,EXT400
u;`tiw'2+ FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00222
APPLICANT TONIA NEAL Phone: 425.246.2785
Address: 191 DEYETTE LANE SHELTON, WA 98584
OWNER DEYETTE LANCE Phone:
Address: 8431 W SHELTON MATLOCK RD SHELTON, WA 98584
SEPTIC DESIGNER Adam Hunter-Jim Hunter and Phone: 360-753-1226
Associates
Address: PO Box 162 OLYMPIA, WA 98507
Site Address: 191 W Deyette Rd
Primary Parcel Number: 421162300020
Permit Description: New SFR -3BR Pressure
Permit Submitted Date: 06/05/2023
Permit Issued Date: 06/29/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $780.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 06/29/2026 (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 Drainfield 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
4 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.
' — -- OFFICIAL USE ONLY
MASON COUNTY PUBLIC HEALTH DATE RECEIVED:
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ONSITE SEWAGE SYSTEM APPLICATION AMOUNT RECEIVED: RECEIVED BY: v rn
415 N 6th Street,(Bldg 8) Shelton WA,98584 �Q < N
SWG �va�
Shelton:360-427-9670 ext 400 Belfair:360-275-4467 ext 400 - Ooa,Q,: . g O
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APPLICANT
ONIA NEAL 4252462785 m m
MAILINVDDRESS-STREET.CITY.STATE,ZIP CODE
191 DEYETTE 114 Q(' SHELTON WA 98584 z
SITE ADDRESS-STREET.CITY.ZIP CODE W
191wDEYETTE SHELTON WA 98584
NAME OF DESIGNER PHONE
ADAM HUNTER 3607531226
NAME OF INSTALLER PHONE
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TBD v r—
CHECK ALL APPLICABLE ITEMS DRINKING WATER SOURCE <
❑ NEW CONSTRUCTION 0 RV HOLDING TANK ONLY 0 PRIVATE INDIVIDUAL WELL E
i REPLACEMENT SYSTEM 0 INSTALLATION PERMIT ONLY ❑ PRIVATE TWO-PARTY WELL 0
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❑ TABLE 9 REPAIR 0 SINGLE FAMILY LJ COMMUNITY/PUBLIC WATER SYSTEMZ r
❑ TANK(S)ONLY 0 COMMERCIAL SYSTEM NAME: I 1
❑ UPGRADE TO EXISTING 0 OTHER: BEDROOMS LOT SIZE /�-r
❑ EXISTING FAILURE "Record Drawing required 3 1.71 W { U
for all Installations" P. I"
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DIRECTIONS TO SITE-BE SPECIFIC AND ADVISE OF ANY NEEDED INFORMATION FOR ACCESS(ex.locked gate) 0I_
WEST ON SKOKOMISH VALLEY RD TO A LEFT ON DEYETTE LN TO SITE ON THE x
RIGHT -:--
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SITE MU'--.E FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS
-- __ - OFFICIAL USE ONLY BELOW THIS LINE
I UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT El HOME SALE ❑COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
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SOIL CODES: N
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS ("`.)
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ECT R SIGNATURE DATE APPLICATION EXPIRATION DATE AP L ATI N APPROVED BY DATE 'Uj(C 7 2:V. ,9./ 4S-0 ._ U A'\,011__ Co-2Y-----Zi
1S R MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSIT REVISED 12/7/2015
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DESIGN FORM—PAGE ONE Assessor's Parcel Number: 4QZL 1.6 -- a2 -- L1I a_O...
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 IDENTIFICATION
Permit Number: SWG& 3-��--�-``�b�8a. Designer's Name: ADAM HUNTER
TONIA NEAL 360-753-1226
Applicant's Name: Designer's Phone Number:
191 DEYETTE LN PO BOX 162
Mailing Address: Designer's Address:
SHELTON WA 98584 OLYMPIA WA 98507
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:
Drainfield Type
❑Gravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class PER GLENDON
Daily Flow: Operating Capacity 270 gpd Length PER GLENDON ft
Daily Flow: Design Flow 360 gpd Diameter PER GLENDON in
Septic Tank Capacity 1200 gal Number PER GLENDON
Receiving Soil Type(1-6) 2 Separation PER GLENDON ft
Receiving Soil Appl. Rate 0.2 gpd/ft2 Orifices
Required Primary Area 1800 ft2 Total Number of Orifices PER GLENDON
Designed Primary Area 1800 ft2 Diameter PER GLENDON in
Designed Reserve Area N/A ft2 Spacing PER GLENDON in
Trench/Bed Width SEE DESIGN ft Manifold
Trench/Bed Length SEE DESIGN ft Schedule/Class 40
Elevation Measurements Length 50
Original Drainfield Area Slope 0 % Diameter 1 in
New Slope,If Altered 0 % Preferred manifold configuration used? 'Ycs 0 No ft
Depth of Excavation Up-slope N/A in Transport Pipe
from Original Grade Do -slope N/A in Schedule/Class 40
Designed Vertical Separation 9 in Length 200 ft
Gravelless Chambers Required? 0 Yes VNo 0 Optional Diameter 1 in
Pump Required? sfYes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day PER GLENDON
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity PER GLENDON gal
Orifice PER GLENDON ft Chamber Capacity PER GLENDON gal
Uppermost Orifice Higher 0 Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head PER GLENDON m Vfimer 6Itlapse Meter aEvent Counter
Calculated Total Pressure Head PE il;1 s 0 V FT Pump on PER GLENDON pump off PER GLENDON
Comments i
JUN 2 9 2023
MASON COUNTY ENVIRONMENTAL HEALTH
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DESIGN FORM-PAGE TWO Assessor's Parcel Number: a 1 i_(Q -- 02..3 -- 0_oil 42
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
6Zr Test hole locations E' Drainfield orientation and layout Reference depth from original grade:
g Soil logs 6 ' Trench/bed dimensions and EC Septic tank
g Property lines critical distances within layout a Drainfield cover
0 Existing and proposed wells 6t D-Box/Valve box locations Reference depth from original grade
within 100 ft of property l Septic tank/pump chamber and restrictive strata:
Cif Measurements to cuts,banks,and locations 0 Laterals,trench/bed,top and
surface water and critical areas 6 ' Observation port location bottom
g Location and orientation of 0 Clean-out location 0 Curtain drain collector
curtain drain and all absorption El Manifold placement 0 Sand augmentation
components 6l Orifice placement Other cross-section detail:
g Location and dimension of Iii Lateral placement with distance 6l Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
62f Buildings 62f Audible/visual alarm referenced Yes No
121 Direction of slope indicator 6l Scale of drawing shown on scale 12f 0 Design staked out
12i Waterlines bar 0 0 Recorded Notices attached
gRoads,easements,driveways, p
p R 0 V ❑ ❑ Waiver(s)attached
parking ❑ 0 Pump curve attached
g North arrow and scale drawing JUN 2 9 2023 o ❑ Evaluation of failure
shown on scale bar Non-residential justification
6ASONCOUNTY ENVIRONMENTAL HEALTH ❑ 0 Waste strength
JBW ❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be()title qs
inst. - .t time of installation Ilit Yes ❑ No
6/5/23
Si a'a - 1Designer Date
The undersigned has reviewed this des u on behalf of Mason County Public Health and determined it to be in
compliance with state and local on-site regulations:
0 /•-te‘ (A I 11A/eV C-2q—2-3
Envir• fig 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: CO -,W 2 0
✓ 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
PAGE
MASON COUNTY HEALTH DEPARTMENT
ON-SITE SEWAGE DISPOSAL SYSTEM DESIGN
SITE#: PARCEL#: 421162300020
DATE SUBMITTED: 6/5/2023 LEGAL/LOT#:
SUBMITTED BY: ADAM HUNTER
APPLICANT: TON IA NEAL
ADDRESS: 191 DEYETTE LN
SHELTON,WA 98584
I.CALCULATIONS
NUMBER OF BEDROOMS= 3
RESIDENTIAL GPD FLOW = 360
IF NON-RESIDENTIAL-GPD FLOW
WILL BE AS FOLLOWS:
GPD=
APPLICATION RATE= 0.2 GPD/FT2
REDUCTION =LEAVE BLANK IF NO REDUCTION TAKEN
DRAINFIELD SIZING
ABSORPTION AREA= 1800 FT2
TRENCH LENGTH OR BED CONFIG. = PER GLENDON
II.WATERPROOF SEPTIC TANK
COMPOSITION AND SIZE= 1200 GAL-CONCRETE
NEW OR EXISTING= NEW
III.DRAINFIELD CROSS SECTION
DEPTH TO DRAINROCK BOTTOM= N/A
ROCK DEPTH BELOW PIPE = N/A
SEPARATION FROM TRENCH BOTTOM TO IMPERMEABLE
MATERIAL/SEASONAL SATURATION = N/A
FILL DEPTH = N/A
TRENCH WIDTH= N/A
PPROVE
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6/5/23 MASON COUNTY ENVIRONMENTAL2023 HEALTH
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