HomeMy WebLinkAboutSWG2023-00287 - SWG Application / Design - 7/6/2023 0,,., ,,,, MASON COUNTY 415 N 6TH STREET,6SHELT967 WA 98400
SHE TREE ,S 42 TON, ,EXT 400
584
BELFAIR:360-275-4467,EXT 400
P Public Health & Human Services ELMA:360-482-5269,EXT 400
•u� ;' FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00287
APPLICANT MARLA CLARY Phone:
Address: 16401 NE 63RD CIRCLE VANCOUVER, WA 98682
SEPTIC DESIGNER BRAD SMITH-septic designer Phone: 253-851-2178
Address: PO BOX 1444 GIG HARBOR, WA 98335
Site Address: 931 SE Mill Creek Rd
Primary Parcel Number: 320294450030
Permit Description: New 4BR SFR -Gravity
Permit Submitted Date: 07/06/2023
Permit Issued Date: 08/04/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 08/04/2026 (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.govlhealth/environmental/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
MASON COUNTY PUBLIC HEALTH DATE RECEIVED: -
, .� 3
ONSITE SEWAGE SYSTEM APPLICATION AMOUNT RECEIVED: c� RECENEDBY: C U)
415 N 6th Street,(Bldg 8) Shelton WA,98584 < N
Shelton:360-427-9670 ext 400 Belfair:360-275.4467 ext 400 C p G c c c _ ��--7 fa p
J V V OK� ( Z 73
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APPLICANT PHON D
f' 1\f R�j 1) .1-0 4 1 8l m m
MAILING ADDRESS-STREET,CITY,STATE,ZIP C r
1C c�1 �� c.i2. C
SITE ADDRESS-STREET.on:ZIP CODE
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xi
NAME OF DESIGNER PHONE
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NAME OF INSTALLER PHONE I
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CHECK ALL 1CABLE ITEMS DRINKING WATER SOURCE v t y
NEW CONSTRUCTION CI RV RV HOLDING TANK ONLY 0 PRIVATE INDIVIDUAL WELL I l r
❑ REPLACEMENT SYSTEM ❑ INSTALLATION PERMIT ONLY 0 PRIVATE TWO-PARTY WELL Z A N
❑ TABLE 9 REPAIR ❑ SINGLE FAMILY COMMUNITY/PUBLIC WATER SYSTEM
❑ TANK(S)ONLY 0 COMMERCIAL SYSTEM NAME:
❑ UPGRADE TO EXISTING ❑ OTHER: BEDROOMS LOT SIZE I `
❑ EXISTING FAILURE "Record Drawing required
` !/ I V/k- /J f�l )t CO
for all Installations"
DIRECTIONS TO SITE-BE SPECIFIC AND ADVISE OF ANY NEEDED INFORMATION FOR ACCESS(ex.locked gate) 00 t
OL,.." J co,./7-1 .------4-60.)L, _ 4-- - / -.TD-"I , NI 1`--)
0 t\S)-0 ,NA 1 t ) C.t.,/tr2...--kl 'iLd c),)-3 70 E.--t--) 1 II , r...- IN\
-CI-- 17-6:7.- C).A3 rz_.i i,7-- -i cy N.,
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS
OFFICIAL USE ONLY BELOW THIS LINE
v 1`
UPGRADE/FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ❑COMPLAINT 0 OTHER:
INSPECTOR SOIL LOGS COMMENTS 1 CONDITIONS •
v ll 14995 Q-c ,
( 2.o l at - ' 3 7/ Gr l ?.
a
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SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R-ROOTS
I. - CTOR SIGNATURE DATE APPLICATION EXPIRATION DATE !CATION APPROVED BY DATE
\ ... 11)(J4)(LIA i .((r)-3 X° 0 •Iiii/6117N -(/-.)-3
THI F Y BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSIT REVISED 12nn015
y1 -- ,s063c>
DISIGN FORM—PAGE ONE Assessor's Parcel Number: i 2—c)1 -- '
A design will be reviewed when 3 conies of each of the following are submitted:
0 Completed design final that has been signed and dated. ''Scaled layout sketch,including all applicable items on checklist
v 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 forpubiic view on the Mason County Web site,Maximum paper size: 11"X 17"
P R E 1.6ENT t(AflbN: ,_ ., , ._
Permit Number: SWG ,;(5a,3• (�1 Designer's Name: __
Applicant's Name: tA, ( Designer's Phone Number: ' �1 J i—2..r7iA
..
Mailing Address: I. D Designer's Address: i(", ,: l c
U Rtvc U J LSt toM 9e- Cry' r 04-',A 1`,if. t~ Z
CityZip Cyr State Zip
f 6s f,_ . >'y f ~'x ;:.� 3?E-SlON:PARAMETERS. ,..:� 7 . ,=
Treatment Device
0 Glendon Biofilter ❑Sand Filter 13 Mound 0 Sand Lined Drainfield 1:3 Recirculating Filter,Type:
0 Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
•
Drainfield Type
0-Gravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms ��' Schedule/Class r71-1 2 12_9
-1 Daily Flow: Operating Capacity 0 0 gpd Length C) ft
Daily Flow:Design Flow z{"SQ gpd Diameter in
Septic Tank Capacity J 250 gal Number
Receiving Soil Type(1-6) 'G{ Separation ft
Receiving Soil Appl.Rate .6v.i!) gpd/ft2 Orifices
Required Primary Area OCJ ft2 Total Number of Orifices tJ/q
Designed Primary Area g U 0 ft2 Diameter in
Designed Reserve Area e(77 ft2 Spacing 7 in
Trench/Bed Width ;,;i ft Manifold 1
Trench/Bed Length —7() ft Schedule/Class 1 J/
Elevation Measurements Length ft
Original Drainfield Area Slope 0 % Diameter in
l
New Slope,If Altered % Preferred manifold configuration used? ❑Yes 0 No
Depth of Excavation lip-slope (B in Transport Pipe
from Original Grade Down_slope t S in Schedule/Class - 1A, T '"
Designed Vertical Separation 4'\ in Length 0 ft
Gravelless Chambers Required? 0 Yes ❑No !Donal Diameter G in
Pump Required? 0 Yes lallo Dosing and Pump chamber
Pump/Siphon Specifications Number of doses/day /A
Difference in Elevation Between Pump Shutoff,and Uppermost Dose quantity gal
Orifice 1 ft Chamber Capacity gal
Uppermost Orifice 0 Higher 0 Lower than Shutoff Pump controls:Please check those aired.
Capacity @ Total Pressure Head /J gpm ❑Timer ❑Elap eter,,,, 0 Event Counter
Calculated Total Pressure Head /kJ/Pi ft If Ti • P ')limp off
Comments P R
AUG 042023
"1A80N COON l r ENVIRONMENTA� EL HEALTH
JBW
yy fio030
,DESIGN FORM—PAGE TWO Assessor's Parcel Number:3 202� — —
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan :rid Layout Sketch Cross-Section Sketch
est hole locations ainfield orientation and layout Referenc th from original ade:
eP �
l�oil logs 21 Trench/bed dimensions and [ eptic tank
operty linescritical distances within layout Drainfield cover
1 Existing and proposed wells D -Box/Va1ve box locations Reference depth from original> de
P
mthin 100 ft of property Of Septic tank/pump chamber and restriptive strata:
easurements to cuts,banks, and locations 0 Laterals,trench bed,top and
surface water and critical areas Of/Observation port location
surface
Location and orientation of lean-out location 0 Curtain drain collector
curtain drain and all absorption ❑ Manifold placement 0 Sand augmentation
omponents 0 Orifice placement Other c less-section detail:
Location and dimension of Lateral placement with distance t Observation ports/clean-outs
/primary system and reserve area to edge of bed
Q uildings Other Information
�❑ dible/visual alarm referenced Yes No , ---
irection of slope indicator Ca' Scale of drawingshown on scale 0 E Desl staked out
oti:67 aterlines �
bP R o
❑ EigRecorded Notices attached
oads,easements,driveways, ❑ ❑'Waiver(s)attached
V E
parking ❑ ❑ curve attached
North arrow and scale drawing AUG 0 4 2023 ❑ CI Evaluation of failure
shown on scale bar MASON COUNTY ENVIRONMENTAL HEALTH Non-residential justification
J B w ❑ ❑Waste strength
❑ ❑ Flow
D EFS1GI4.A!P ROVAL
The undersigned designer must be noli d y installer at ti of installation 0 Yes ❑ No
Signature of De\si _ — - 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 on-site regulations:
En re L• • al 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: 7 —4 m24
✓ 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.
I
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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