HomeMy WebLinkAboutSWG2023-00311 - SWG Application / Design - 7/25/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
. 44 ..,,,,.
BELFAIR:360-275-4467,EXT 400
.- '� Public Health & Human Services ELMA:360-482-5269,EXT400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00311
APPLICANT SIMON KENNETH D & DIANE P Phone:
Address: PO BOX 1622 ABERDEEN, WA 98520
OWNER SIMON KENNETH D & DIANE P Phone:
Address: PO BOX 1622 ABERDEEN, WA 98520
SEPTIC DESIGNER DALE TAHJA-Septic Designer Phone: 360-426-5940
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: 341 N Duckabush Dr E
Primary Parcel Number: 422095000163
Permit Description: New SFR-2BR sand lined bed
Permit Submitted Date: 07/25/2023
Permit Issued Date: 09/06/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $780.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 08/01/2026 (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
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/healthienvironmentallonsite/oss-inspection-request.php or call:
360-427-9570, extension 400.
Aar
Qi
OFFICIAL USE ONLY C
DATE RECEIVED: -- I�^ 5 1 C coMASON COUNTY y/
II. COMMUNITY SERVICES AMOUI CENE6 - RECEIVED BY:
• Public Health(Community Health/Environmental Health) v R (/)
360477-9670,ext 400 or 760-275-4+67.ext.400 (\` /�' ^^^/� "may\��\� /�
415 N_6th Street-Stet.",WA WM ✓W 1 1'V\lv`/)•' J —
\_/`/ �t k` Z N
13
ON-SITE SEWAGE SYSTEM APPLICATION 3
m n
APPLICANT PHONE m
Diane Simon (360) 249-0308 1— c
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE .' E
P.O. Box 1622 Aberdeen WA 98520 n M
SITE ADDRESS-STREET,CITY,ZIP CODE c
341 N. Duckabush Dr. E. Hoodsport WA 98548 (414,
NAME OF DESIGNER PHONE Ir .116(00)1V ir 1 I N
Dale L. Tahja (360) 426-5940 1[quil
NAME OF INSTALLER PHONE 'JL! _ 2 5 2023 L, v I IV
T.J. Goos (360) 490-0217 _<
PERMIT TYPE(select one) DRINKING WATER SOURCE i�+r, -
tYl.RESIDENTIAL OSS b7COMMUNITY OSS ECOMMERCIAL OSS 57 PRIVATE INDIVIDUAL WELL bT PRIVATE TWO-PARTY LL Z
TYPE OF WORK(select one) 1'PUBLIC WATER SYSTEM Lake Cushman Water Co. I CO
r
NEW CONSTRUCTION/UPGRADES ffREPAIR/REPLACEMENT OTHER DETAILS(select all thatappty) 0 TABLE IX REPAIR I (XiSUBMITTALS � CI SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
CO
lir DESIGN FORM(REQUIRED) KISEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE G I so
glWAIVER(S)(IF APPLICABLE) 2 0.22 acre o I I
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) C
Go to Hoodsport, left on Lake Cushman Rd., left on Duckabush Way, left on Duckabush Dr. I
E., property on the left, one lot before 361 N. Duckabush Dr. E. o
, Io
0)
co
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I CO
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
. ,4C-4‘ .. g-4"
0 2- 5- \-, ,....H' 4AA-L.,,--( '
.( - —),2- 41/J2
'\ .3- I-- t -A(.:::'. hr..• ' '
fir, , ; ;
e
RECORD DRAWING AND INSTALLATION REPORT '1
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM SI=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
aLi
ECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE 'LIGATION AP OVEDI ISSUED BY DATE
i � ,
T IS MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
r i
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 4 2 2 0 9 — 5 0 — 0 0 1 6 3
A design will be reviewed when 3 copies of each of the following are submitted:
v 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. 'I 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 2023-00311 Designer's Name: Dale Tahia
Applicant's Name: Diane Simon Designer's Phone Number: (360)426-5940
Mailing Address: P.O.Box 1622 Designer's Address: 2450 W Deegan Rd W
Aberdeen WA 98520 Shelton WA 98584
City State Zip City State Zip
DESIGN PARAMETERS'
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound g Sand Lined Drainfield D Recirculating Filter,Type:
❑ Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
0 Gravity fit Pressure 0 Trench Cif Bed 0 Sub Surface Drip
ISeptic Tank/Drainfield Specifications , Laterals
Number of Bedrooms 2 Schedule/Class Sch.40
Daily Flow:Operating Capacity 180 gpd Length 27 ft
Daily Flow:Design Flow 240 gpd Diameter 1.25 in
Septic Tank Capacity(working) 500 gal Number 3
Receiving Soil Type(1-6) 1 Separation 3 ft
Receiving Soil Appl.Rate 1.0 gpd/ft2 Orifices
Required Primary Area 240 ft2 Total Number of Orifices 42
Designed Primary Area 240 ft2 Diameter 1/8 in
Designed Reserve Area 240 ft2 Spacing 24 in
Trench/Bed Width 9 ft Manifold
Trench/Bed Length 27 ft Schedule/Class Sch.40
Elevation Measurements Length 6 ft
Original Drainfield Area Slope 0 % Diameter 2 in
New Slope,If Altered 0 % Preferred manifold configuration used? 0 Yes 66 No
Depth of Excavation Up-slope 46 in Transport Pipe
from Original Grade Down slope 46 in Schedule/Class Sch. 40
Designed Vertical Separation 3 in Length 40 ft
Gravelless Chambers Required? 0 Yes 0 No g Optional Diameter 2 in
Pump Required? liti Yes ❑No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 4
Diff. in Elevation Between Pump&Uppermost Orifice 12 ft Dose quantity 45 gal
Drainfield Squirt Height/Selected Residual(head) 6 ft Chamber Capacity(flood) 1,000 gal
Uppermost Orifice 13'Higher 0 Lower than Pump Shutoff Pump controls: t eMitgrfd
Capacity @ Total Pressure Head 20 gpm [ifTimer s e rj E vent Counter
Calculated Total Pressure Head 24 ft If Timer: P5o Pump o ';'Ir •57.75 min.
5 2023
Comments
MASON COUNTY ENVIRONMENTAL HEALTH
Revisions
JBW
r
DESIGN FORM—PAGE TWO Assessor's Parcel Number:4 2 2 0 9 — 5 0 -- 0 0 1 6 3
Permit Number: SWG 2023-00311
DESIGN CHECKLISTS -4,,:', '-'2..;_
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
O Test hole locations W( Drainfield orientation and layout Reference depth from original grade:
0 Soil logs WI Trench/bed dimensions and WI Septic tank
WI Property lines critical distances within layout 65 Drainfield cover
0' Existing and proposed wells WI D-Box/Valve box locations Reference depth from original grade
within 100 ft of property WI Septic tank/pump chamber and restrictive strata:
WI Measurements to cuts, banks,and locations G21 Laterals,trench bed,top and
surface water and critical areas 6d Observation port location bottom
O Location and orientation of WI Clean-out location 0 Curtain drain collector
curtain drain and all absorption WI Manifold placement W Sand augmentation
components 621 Orifice placement Other cross-section detail:
WI Location and dimension of WI Lateral placement with distance WI Observation ports/clean-outs
primary system and reserve area to edge of bed
0 Buildings Other Information
WI Audible/visual alarm referenced Yes No
• Direction of slope indicator iii Scale of drawing shown on scale l� 0 Designstaked out
i Waterlines b 0 0 Recorded Notices attached
O Roads,easements,driveways, p RIN w 4", i/ e. Cif ❑ Waiver(s)attached
parking ;F ij kti '' a g 'w',', 62( ❑ Pump curve attached
0 North arrow and scale drawing StP u 5 2023 •J ❑ ❑ Evaluation of failure
shown on scale bar lU?ASON COUNTY ENVIRONMENTAL yEq�T Non-residential justification
❑ 0 Waste strength
JBW 0 ❑ Flow
DESIGN APPROVAL .' ` *"
The undersigned designer m notified b •nst a time of installation WI Yes 0 No
PM
Signature of Designer Date �+ rl` ;
+. ,cc
The undersigned has reviewed this •- _+ on behalf of Mason County Public Health and dete i,T1� o••- n< _ %
compliance with state and local • -site r gulaf•ns: Lit/ )71/Ne(i.. ctc.2 �. Q;;,,If CO
J `**
Envi,•nmen . - lth Specialist Date 1‘ 6'=�j���3e,s ��y. .
�` 'GCS••- ca'w 1 r.
CAUTION: DESIGN APPR t AL IS VALID ONLY UNDER THE FOLLOWING CON I'1t� ` • '� `'"'
✓ The design is stamped"A..roved"by Mason County Public Health. s,, - ),
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: — 1 —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.
This form may be scanned and available for public view on the Mason County Web site.
Updated Date: 12/7/2015
o
c
;na'. ' i 1)-- r/= 0
F ri, ro , 0 (S)— I
___...... . • . „,,,,
0-- a 5 '�
reLA " `Y `�" `: , ,
�vck 0
' l2.S..\::1___S)s.:„.....
b SAA, �_
• I i -_i'
0
ok- i • • 1
frf
--g 41\31/41 • •
. ,
ru
2. % f ' sr
If
re
•
•
0 I•
`- Q Aar_
,,p, ;, •
....‹-c - -'
I ,,..„- . R
a , •
It.. .-, k 6, _
.. )"' -4 n-v 1 t 0
4
.__I _ ,..
ini
APPRO •
-
SEI' 0 5 2023 , E •
MASON COUNTY ENVIRONMENTAL HEALTH 16-7.---4,,,4—crCii
G
JBW „,(-NA0
,
•
•
... .fzek.r:\,e . - , _ .
•
•
,fi \N\li SZZ.2,4\C-- !
:iv ---. duriler
Eo0 .1
lt
• f _
ti
.
gt--•--._. -- •._-——.._...•w_. .. •- .•.._— • . • • • ---_-_-,,.
r 3 ►�
- i AI -� . iiit s
YS7 11 ,\1 �11
q.)4.. . . - . 4. p
, �'
•
jJFQVE
SEP 5 2023 i. 4 MASON i\,W
.
i
''JJ fP / 1411Lie...........,
ice'
'•.:�'1^ , ot ; ►,'' .I,
3V' ' r. \"-'d` 1', *'y 1 p,,771. ^.* {7��� ', '4;'!--..•
•,1
4 , , :.1 .-.,,(. yr ; ,r , .',j• -, 36 ,, ,' , .)- fA
•; rr�..r',..fr `� ,.A- •,�•r� r, �,, i i ,,, t GXJ�.'f� ' c Q Y^ 11
✓ #1;r ti^ ,1•4 `c ' r•• I .
1" r..• .r 1' tom•'' ,,1` %.•• ;,y'`)(
,,,.100 Q; ` , y��� . .,,,•,.. ':`r t•;�r�Rrr-.L ,_ .. rw-,el' "•'�, ,'if,<-'C���-r•hic,:-!'�,r-+a _
Oil g 0
OQ0 ' DALE L. TA_H '� 't• • - T
�1K ' SED D SIGNER O
i.
Media Gallery X
Liberty Pumps 280 - 1/2 HP Cast Iron Submersible Sump/Effluent Pump (Non-
Automatic)
Performance Curve: 280-Series .<\
40 r- , T f f -1 -Y--.,.._ i T
35 Ili - ;'' 441._ 11" 1 i ; i , i
= � Sri,
f a
30 '4�.--.IUIIiItLiI ._ . ,.
a)
a) 25 .. .._--- `'ilia►�. ;1-2?".*-- ' 4 ' - ' -�-' i .
�/ X S LjM f 20 I 1Riill: +. $ . i t }
al 15 ......�... .....j._ .. I i71 s �.
1 .�. ....4.4
I10 , � _ . I i1 i ; t
— ' I-- i f -1----F-1---, — •
5 ---4--- i i 1- r4 -t4 1 1 bk. _Jr...1
. ..I T i !._.' ; i 1 , e _1 ; ..� _:_, J _. a
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
U.S. Gallons Per Minute
PpROP
4 SE yLs
r�A c p 5
� 2023D
Nrr 6vo
Je , 1sN741 HEAt71.,
.
Installation/Maintenance
Pressure Distribution/Bed Systems
1. Install bed bottom level and in contour with the ground.
2. Install drainfield during dry weather and soil conditions.Any soil smearing must be
eliminated by hand raking any areas that get smeared.
3. Install audio/visual high water alarm.
4. Install effluent filter in septic tank outlet or pump vault with 1/16 inch maximum
filtration mesh size.
5. Install check valve in pump outlet line to prevent back-flow into the pump chamber.
6. Install 1/8 inch orifices on 24 inch. centers. Install the orifices pointing straight down
( 6:00 o' clock).
3 7. Divert all storm water run-off away from septic system components.
8. No curtain(french) drains allowed within 10ft. of the up-slope edge of the drainfield and
reserve area.
9. No curtain(french) drains allowed within 30ft. of the down-slope edge of the drainfield
and reserve area.
10.Have the septic tank and pump chamber pumped or inspected every 3 to 5 years.
11.Inspect and clean pump screen as needed.
12.Inspect floats and test high water alarm every 6 to 12 months or as needed.
13.All material and workmanship must meet County and State requirements.
14.Install risers on septic tank and pump chamber.
15.Deviation from this approved design without prior approval from the Designer and
Mason County Health Department will make this design null and void.
16.The prepared Site Plan is not a survey, it is the owner's responsibility to verify property
line locations prior to installation. Any discrepancies must be reported to the Designer
immediately.
17. Locate all utilities prior to starting installation.
. APpftO
s +� S P
`e ?023if
,,,;0-_ DALE L. TAHJ • 4
1 �'�ISb +. s! NER -