HomeMy WebLinkAboutSWG2023-00272 - SWG Application / Design - 6/26/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHETREE ,S 42 TON, ,EXT 400
584
BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00272
APPLICANT Brad Byron Phone:
Address: 60 N Kings Way HOODSPORT, WA 98548
OWNER SCHULGEN RICHARD K Phone:
Address: PO BOX 467 KEYPORT, WA 98395
SEPTIC DESIGNER Adam Hunter-Jim Hunter and Phone: 360-753-1226
Associates
Address: PO Box 162 OLYMPIA, WA 98507
Site Address: 60 N Kings Way N
Primary Parcel Number: 422165200110
Permit Description: New SFR-2BR Glendon M31
Permit Submitted Date: 06/26/2023
Permit Issued Date: 07/20/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 07/20/2026 (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.
- OFFICIAL USE ONLY `/
MASON COUNTY PUBLIC HEALTH DATE RECEIVED: ' / ram_
ONSITE SEWAGE SYSTEM APPLICATION AMOU TeEc IVED l� •: , o can
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415 N 6th Street,(Bldg 8) Shelton WA,98584 C cn
Shelton:360-427-9670 ext 400 Belfair:360-275-4467 ext 400 S G h �- - () oil it O 2,
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APPLICANT PHONE > D
BRAD BYRON 9135793357 m rn
MAILING ADDRESS-STREET,CITY.STATE,ZIP CODE m
60 N IKINGSWAY N HOODSPORT WA 98548 z
SITE ADDRESS-STREET.CITY.ZIP CODE co
60 N KINGSWAY N HOODSPORT WA 98548 m
NAME OF DESIGNER PHONE
ADAM HUNTER 360-890-2778
NAME OF INSTALLER PHONE
VILLINES EXCAVATION
CHECK ALL APPLICABLE ITEMS DRINKING WATER SOURCE 2
C If NEW CONSTRUCTION 0 RV HOLDING TANK ONLY 0 PRIVATE INDIVIDUAL WELL (A I_
❑ REPLACEMENT SYSTEM 0 INSTALLATION PERMIT ONLY ❑ PRIVATE TWO-PARTY WELL Z is-
❑ TABLE 9 REPAIR ❑ SINGLE FAMILY I' COMMUNITY/PUBLIC WATER SYSTEM
❑ TANK(S)ONLY 0 COMMERCIAL SYSTEM NAME: cusEtmAN I
❑ UPGRADE TO EXISTING ❑ OTHER:_ BEDROOMS LOT SIZE Lil
❑ EXISTING FAILURE "Record Drawing required 2 0.1 9 W
for all Installations" 0
DIRECTIONS TO SITE-BE SPECIFIC AND ADVISE OF ANY NEEDED INFORMATION FOR ACCESS(ex.locked gate) -0 n 1
' JUN 2 6 2023 J
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS
OFFICIAL USE ONLY BELOW THIS LINE-- -
UPGRADE!FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
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SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS
TOR SIGNATURE DATE APPLICATION EXPIRATION DATE APP ATION APPROVED 3Y DATE
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INMAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
DESIGN FORM—PAGE ONE Assessor's Parcel Number:I-10Z aL_6— 59. -- 0 Q 11_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. '1 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 111
Permit Number: SWG )4d 2-3 - C' 0 z 72, Designer's Name: ADAM HUNTER
Applicant's Name: BRAD BYRON 360-753-1226
Designer's Phone Number:
Mailing Address: 60 N IKINGSWAY N PO BOX 162
Designer's Address:
HOODSPORT WA 98548 OLYMPIA WA 98507
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device
Glendon Biofilter ❑ Sand Filter ❑ Mound ❑ Sand Lined Drainfield ❑ Recirculating Filter,Type:
11 ❑ Aerobic Unit Make/Model ❑ Disinfection Unit Make/Model Other:
Drainfield Type
❑Gravity Pressure 0 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class N/A GLENDON
Daily Flow: Operating Capacity 180 gpd Length N/A GLENDON ft
Daily Flow: Design Flow 240 gpd Diameter N/A GLENDON in
Septic Tank Capacity 1000 gal Number N/A GLENDON
Receiving Soil Type(1-6) 4 Separation N/A GLENDON ft
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 400 ft2 Total Number of Orifices N/A GLENDON
Designed Primary Area 400 ft2 Diameter N/A GLENDON in
Designed Reserve Area 400 ft2 Spacing N/A GLENDON in
Trench/Bed Width SEE PLAN ft Manifold
Trench/Bed Length SEE PLAN ft Schedule/Class 40
Elevation Measurements Length 25 ft
Original Drainfield Area Slope 3 % Diameter 1 in
New Slope,If Altered 0 % Preferred manifold configuration used? ®'Yes 0 No
Depth of Excavation Up-slope PER GLENDON in Transport Pipe
from Original Grade Down-slope PER GLENDON in Schedule/Class 40
Designed Vertical Separation >12 in Length 75 ft
Gravelless Chambers Required? 0 Yes tif No 0 Optional Diameter 1 in
Pump Required? EYes 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 ItHigher 0 Lower than Pump Shutoff p an is 1 c hi--- equired.
Capacity @ Total Pressure Head PER GLENDON gpm I�I�et 11 eter ®'Event Counter
Calculated Total Pressure Head PER GLENDON ft Aimertym9 PER GLEN ii Pump off PER GLENDON
LL UU is
Comments MASON COUNTY ENVIRONMENTAL HEALTH
JBW
DESIGN FORM—PAGE TWO Assessor's Parcel Number: L.� L -- - 4 4 O
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
g Test hole locations D' Drainfield orientation and layout Reference depth from original grade:
a Soil logs 21 Trench/bed dimensions and M' Septic tank
DI Property lines critical distances within layout ®' Drainfield cover
Er Existingproposed wells ErD-Box/Valve box locations
and Reference depth from original grade
within 100 ft of property 1' Septic tank/pump chamber and restrictive strata:
o' Measurements to cuts,banks,and locations 0 Laterals,trench/bed, top and
surface water and critical areas E' Observation port location bottom
g Location and orientation of 65 Clean-out location 0 Curtain drain collector
curtain drain and all absorption & Manifold placement 0 Sand augmentation
components ' Orifice placement Other cross-section detail:
g Location and dimension of ' Lateral placement with distance Rif Observation ports/clean-outs
primary system and reserve area to edge of bed
• Buildings g Other Information
t� Audible/visual alarm referenced Yes No
• Direction of slope indicator ' Scale of drawing shown on scale l21 ❑ Design staked out
Ed Waterlines A
P P R O V EDo
0 ❑ Recorded Notices attached
f71 Roads,easements,driveways,
❑ Waiver(s)attached
parking ❑ ❑ Pump curve attached
g North arrow and scale drawing JUL 2 0 2023 ❑ ❑ Evaluation of failure
shown on scale bar MASON COUNTY ENVIRONMENTAL HEALTH Non-residential justification
J B W ❑ ❑ Waste strength
0 0 Flow
DESIGN APPROVAL
The undersigned designer must be n in ller at time of installation larYes 0 No
6/23/23
a re 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 -s. a regulations:
lA (-vt l 7--.20 - 2 3
E it ntal 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: 1' t 2 c
✓ 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
.r.(_:F .
MASON COUNTY HEALTH DEPARTMENT
ON-SITE SEWAGE DISPOSAL SYSTEM DESIGN
SITE#: PARCEL#: 422165200110
DATE SUBMITTED: 6/23/2023 LEGAL/LOT#: LAKE CUSHMAN
#12 LOT 110
SUBMITTED BY: ADAM HUNTER
APPLICANT: BRAD BYRON
ADDRESS: 60 KINGSWAY N
HOODSPORT,WA 98548
I.CALCULATIONS
NUMBER OF BEDROOMS= 2
RESIDENTIAL GPD FLOW = 240
IF NON-RESIDENTIAL-GPD FLOW
WILL BE AS FOLLOWS:
GPD=
APPLICATION RATE= 0.6 GPD/FT2
REDUCTION =LEAVE BLANK IF NO REDUCTION TAKEN
DRAINFIELD SIZING
ABSORPTION AREA= 400 FT2
TRENCH LENGTH OR BED CONFIG. = PER GLENDON
II.WATERPROOF SEPTIC TANK
COMPOSITION AND SIZE= 1000 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
1
A
APPROVE
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JUL 2 0 2023
6/23/23 MASON COUNTY ENVIRONMENTAL
JBW HEALTH
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