HomeMy WebLinkAboutSWG2023-00270 - SWG Application / Design - 6/26/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
�' BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00270
APPLICANT Darrel Andrews Phone:
Address: 13 SE Skookum View Dr SHELTON, WA 98584
OWNER ROBERTS ENID M & HAROLD N Phone:
Address: 230 DAWNVIEW DR SE SHELTON, WA 98584
SEPTIC DESIGNER Bob Paysse -Pioneer Digging Inc Phone: 360-426-1803
Address: 3083 E Mason Benson Road GRAPEVIEW, WA 98546
Site Address: SE Dawnview Dr
Primary Parcel Number: 220294190030
Permit Description: New SFR -4BR Gravity W/ Class B Waiver
Permit Submitted Date: 06/26/2023
Permit Issued Date: 08/15/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 07/19/2026 (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.
I
OFFICIAL USE ONLY
DATE RECEIVED, —
MASON COUNTY c N
' 07 COMMUNITY SERVICES AMOR EIVE6� lil _ Wv m
Public Health(Community Health/Environmental Health)360 `J �n- ^^^��� /' II���� /� N
N.6th Street
et-40 n W 98584 ext.400 S W G I, /; 2 3 /) /,� 1 / \ O 0
415 N.6th Street Shelton,- WA 98584 a-.[/lU UU //�' v
65
ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT PHONE m
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DARREL ANDREWS 360-490-7836 z
MAILING ADDRESS-STREET,CITY.STATE.ZIP CODE g
13 SF SKOOKUM VIEW DRIVE SHELTON WA 98584 co
SITE ADDRESS-STREET,CITY.ZIP CODE
XXX SE DAWNVIEW DRIVE SHELTON WA 98584 I I"
NAME OF DESIGNER PHONE11 1
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ROBERT H. PAYSSE 360-426-1803 u U � I N
NAME OF INSTALLER PHONE J U N 26 2023 I v l CD
PERMIT TYPE(select one) DRINKING WATER SOURCE 1it - I N
IY RESIDENTIAL OSS COMMUNITY OSS F COMMERCIAL OSS EI PRIVATE INDIVIDUAL WELL. - - 2 I
C
TYPE OF WORK(select one) 131 PUBLIC WATER SYSTEM i
Pr NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE IX REPAIR 14'
SUBMITTALS ElSURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE co
1TOF('-!Siv [T FORM(REQUIRED) t�SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r
It WAIVER(S)(IF APPLICABLE) 4 2.02 o I I
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DIRECTIONS TO SITE AND SITE CONDITIONS.(ex.locked gate)
************* GATE: CONTACT APPLICANT PRIOR TO SITE VISIT '`'`"***********
FROM SHELTON OUT ARCADIA ROAD. TURN RIGHT ONTO LYNCH ROAD AND TAKE r o
FIRST ROAD ON LEFT DAWNVIEW DRIVE. TRAVEL DOWN DAWNVIEW TO SITE -
ADDRESS 230 ON RIGHT. TRAVEL THRU GATED DRIVEWAY AND TURN RIGHT ONTO j co
GRASSY ACCESS ROAD TO SITE. SEE SITE PLAN.
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. O
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
VQI.UNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ❑COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
-) (:) (__3 /AA )
• 3( L} (L 6
-I b(C45-01
RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES: -
_`r-`r'"' 6=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL
I ECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
-,kt9 7- -2-3 -2- (3 --2 -IS-.2) 011):Vc_______
S MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISE 12
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4
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 0 2 9 — 4 1 — 9 0 0 3 0
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
stem d plot plan,including all applicable items on checklist. Cross-section sketch,including all applicable items on checklist 1
This form may be scanned and available for public view on the Mason County Web site.Maximum paper size: 11"X 17"
?K _' _. _ . .';`: EL IDEN' 10.1 A' His ` ' -
Permit Number: SWG ,20 _ —c'�7O Designer's Name: ROBERT H.PAYSSE
Applicant's Name: DARREL ANDREWS Designer's Phone Number: 360-426-1803
Mailing F4d�liress: 13 SE SKOOKUM VIEW DRIVE Designer's Address: 3083 E MASON BENSON RD
. SHELTON WA 98584 GRAPEVIEW WA 98546
City State Zip City State Zip
DESIGNPARAORTERS.,
Treatment Device
0 Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
00*+::thic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
IY1Gravity 0 Pressure fi'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4 Schedule/Class 2729 PERF
Dail*Fir.-.,:Operating Capacity 360 gpd Length 40 ft
Daily Flow: Design Flow 480 gpd Diameter 4 in
Septic Tank Capacity(working) 1500 gal Number 5
Receiving Soil Type(1-6) 3 Separation 10 ft
Receiving Soil Appl.Rate 0.8 gpd/ft2 Orifices
h:eyuired Primary Area 600 ft2 Total Number of Orifices - '
Designed Primary Area 600 ft2 Diameter - in
Designed Reserve Area 600 ft2 Spacing - in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 200 ft Schedule/Class 3034
2 ' l Elevation Measurements Length 40 ft
Original Drainfield Area Slope 10 % Diameter 4 in
New Slope,If Altered 10 % Preferred manifold configuration used? gYes 0 No
Depth of Excavation Up-slope ate /4' in Transport Pipe
from Original Grade Down-slope yi13 in Schedule/Class 3034 _
Designed Vertical Separation 18+ in Length <100 ft
Gravelless Chambers Required? 0 Yes Ed No 0 Optional Diameter 4 in
Pump Required? 0 Yes lidNo Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day -
Diff.in Elevation Between Pump&Uppermost Orifice - ft Dose quantity - gal
n ?':::uid 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 ❑Ti p goeftetp 0 Event Counter
Calculated Total Pressure Head - ft If Timer: n pgp -
MASON COUNTY ENVIRONMENTAL HEALTH
Comments AUG 15 2023
-1BW
1 . DESIGN FORM—PAGE TWO Assessor's Parcel Number:2 2 0 2 9 — 4 1 -- 9 0 0 3 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Ed Test hole locations Drainfield orientation and layout Reference depth from original grade:
EZi Soil logs 10 Trench/bed dimensions and &f Septic tank
0 Property lines critical distances within layout g Drainfield cover
10 Existing and proposed wells g D-Box/Valve box locations
s Reference depth from original grade i
within 100 ft of property g Septic tank/pump chamber and restrictive strata:
10 Measurements to cuts,banks,and locations lr,! Laterals,trench/bed,top and
surface water and critical areas 10 Observation port location bottom
10 Location and orientation of 10 Clean-out location 0 Curtain drain collector
curtain drain and all absorption g Manifold placement 0 Sand augmentation
l -_ components 10 Orifice placement Other cross-section detail:
e`3t Location and dimension of 10 Lateral placement with distance 10 Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
10 Buildings lid Audible/visual alarm referenced Yes No
gi Direction of slope indicator I0 Scale of drawing shown on scale g 0 Design staked out
10 Waterlines o 11 Recorded Notices attached
AP P R 0 V E
g 0 Waiver(s)attached
5� Roads,easements,driveways,
parking o 21'Pump curve attached
10 North arrow and scale drawing AUG 15 2023 ❑ g Evaluation of failure
shown on scale bar MASON COUNTY ENVIRONMENTAL HEALTH Non-residential justification
J JBW ❑ 21 Waste strength
❑ 21 Flow
DESIGN APPROVAL
The undersigned designer must be notified by
installer at time of installation 10 Yes 0 No
(2k !cR3
Signature of Design r� 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 regulations: /
v' o Health Specialist ate
A A,A-1,----,
En p
, CAUTION: DESIGN APPRO AL 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" 13 —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.
An Installation Fee is required.
j 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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EXISTING ACCESS TO SITE ////�J<<'
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EXPIRES AN ASBUILTI INSTALL SIGNOFF FEE WILL
BE CHARGED AT TIME OF INSTALLATION
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PIONEER. DICING INC. CUSTOMER: DARREL ANDREWS TEST HOLE I: TEST HOLE 2: TEST HOLE 3:
0-46 GAS 0-36 GAS 0-so�\�
PARCEL# 22029 4190030 46+MOTT/WEJ ES 36+MOTT/WEE IS 36+.M0"IT/WEI I S
SEPTIC DESIGNS ADDRESS: XXX SE DAWNVIEW DR ROOTS @ 46 ROOTS @ 36 ROOTS @ 36
3083 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT HDISCLAIMER TNq IS NOT A SURVEY.REFERENCES INCLUDE.APPLICANT/COUNTY PROVIDED
PAYSSE ry PLATS OR SURVEYS.FIELD MEASUREMENTS MD COUNTY GIS DESIGN INTENDED FOR SEPTIC
OFFICE 360 4261803 FAX 360 427 2353 SHEET: SITE PLAN SCALE IN=SV DEPARTIAPURPOSEE ONLY PROPOSED DEVELOPMENT MAY BE SUBJECT TO OTHER
NT AGENCY RENEW CESJGNER NOT RESPONSIBLE FOR SETBACKS UNRELATED TO
SEPTIC COUPONENTS.
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• AN ASBUILTi INSTALL SIGNOFF FEE WILL D-BOX
BE CHARGED AT TIME OF INSTALLATION Ii) (SEE DETAIL)
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PARCEL# 22029 4190030 }6 ;gyp l�',wEr FS 36+MO IT/WFT FS 36+\10TT/NT.T I S
SEPTIC DESIGNS ADDRESS: XXX SE DAWNVIEW DR ROOTS @�6 ROOTS @ 36 ROOTS @ 36
3( 33 E MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT FL PAYSSEDISCLAIMER SURVEYS I THIS IIS ELDOT�URASUREMENTS AND COUNTY G1$ DESIGN INTENDED FOR SEPTIC
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IInstallation & System Notes
1. li4stdlier must contact designer for final inspection of the installation prior to cover. All components, including tanks, lids,
transport line,drainfield,and water lines must be open for inspection. A$350.00 fee will be charged for time involved with the
inspection of the installation and creation of the record drawing. The designer reserves the right to charge additional fees if
multiple visits are needed due to installation errors or inaccessible components.
2.This septic design must be installed by a certified installer with the local health department. All components shall be installed
aecording to state, county, and manufacturer requirements. For Homeowner Installs,the owner must get approval trom he
designer and local health department prior to attempting installation.
3. Designer is not a surveyor. Installer must familiarize themselves with property line locations prior to installation. Any
confusion or conflicts with line locations should be reported to the property owner. A licensed surveyor may be necessary prior
to installation to confirm all line locations. Any discrepancies found must be reported to the designer immediately.
4. Drainfield area may only be cleared by a licensed installer familiar with sensitive drainfield area preservation. The builder, lot
developer, or property owner shall not clear the drainfield area. Any clearing required for drainfield installation shall not
remove or disturb any top soil in Primary and Reserve areas. Removal or disturbance to drainfield soils could render design
void.
5.The property owner and installer are responsible for locating all underground utilities (ex. water,gas, electric) prior to
11 installation. Any utility locations shown within design drawings are likely approximate and may not be exact.
6.All proposed tanks must be installed on original soils or compacted gravels. Extend all tank connection lines out onto original
soil to avoid settling issues. Risers and lids must be brought to finished grade and left accessible for future operations and
maintenance. Component manufacturers (ex. ATU, Glendons,) may have other requirements not listed within this design.
7. All electrical wiring shall be done by a licensed electrician or homeowner(if allowed) and must be permitted through Labor
nd;Industries.
8. The proposed septic system should be installed in dry weather conditions. Any failed attempts at installation during wet
weather conditions may render this design void.
9. Maintain 10ft to waterlines with all septic components. If less than loft is required, sleeving in sch. 40 pvc is required. If
sewage transport lines and waterlines must cross,waterline must be 18" above sewage line with one of the lines sleeved in sch.
40 pvc loft in each direction of crossing.
10.This design may include waiver applications with specific mitigation measures pertaining to installation,operation and
maintenance of the proposed components.
11.Stormwater runoff,footing drains, roof drains must be diverted away from any septic system components. No curtain,
foundation, perimeter drains shall be installed 30ft downslope and loft upslope of drainfield areas.
17."ir'h`l4`i.W.lgn is site specific and intended to meet state and county requirements that are related to the system components
being proposed. Any placement of proposed buildings, proposed wells or other non-related items on these drawings may or
may not meet other requirements. p
13. All onsite septic systems require regular maintenance to verify satisfactory operatio e�ystPmRr®/c� o
il
responsible for the continuous operation and maintenance of the system per WAC 24 . Fo r tion and i : ce
p
information, refer to Mason County Public Health Homeowner's Manual,which shoul ceive"ti'fte 5s ion •-e^'al.
4f SON COUNTY E
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14. System owner should be cautious of landscaping around septic components. Root intrusion 11MENtA�HEALTH
can cause premature failure of the drainfield area. In addition, bushes and trees should be kept JBW
away from lids and other septic maintenance points.
15. Changes made at time of installation may impact designer calculations, pump sizing,and `art+v.
t
comply@nce.w/county and state requirements. Contact designer prior to install w/any ,..
e
proposed variations from design. Changes may result in additional fees and permitting. ' 7'
PIONEER DIGGING INC. CUSTOMER: DARREL ANDREWSilb- •
O PARCEL#22029 4190030 r 1IIQ.. aoaeR mow !`'`
SEPTIC DESIGNS ADDRESS: XXX SE DAWNVIEW DR h_. -: •.�;1'.g..
3 MA o\BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ROBERT H.PAYSSE ExF`F`° 00w:4i:11.
OFFICE-360-426-1803 FAX-360-427-2353 SHEET: NOTES SCALE NA