HomeMy WebLinkAboutSWG2023-00344 - SWG Application / Design - 8/15/2023 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,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00344
APPLICANT RAY DOUGLAS L SR& NANCY F Phone:
Address: PO BOX 61 BELFAIR, WA 98528
OWNER RAY DOUGLAS L SR& NANCY F Phone:
Address: PO BOX 61 BELFAIR, WA 98528
SEPTIC DESIGNER Jim Zimny-Advantage Pero& Design Phone: 360-516-7287
Address: 7178 WINDFLOWER PL NW SEABECK, WA 98380
Site Address: 991 NE Larson Blvd
Primary Parcel Number: 123315100009
Permit Description: 3-bedroom gravity system repair
Permit Submitted Date: 08/15/2023
Permit Issued Date: 08/31/2023
Issued By: David Anderson
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 08/23/2026 (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/health/environmental/onsiteloss-inspection-request.php or call:
360-427-9670,extension 400.
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OFFICIAL USE ONLY
MASON COUNTY DATE
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT PHONE m
NancRay 360275-5475 Z
MAILING ADDRESS-STREET,CITY,STATE.ZIP CODE Yri
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991 NE Larson Blvd, Belfair wa 98524 m
SITE ADDRESS-STREET,CITY,ZIP CODE '1^
991 NE Larson Blvd, Belfair wa 98524 \c I—
NAME OF DESIGNER PHONE
Jim Zimny 360-516-7287 c IND
NAME OF INSTALLER PHONE
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PERMIT TYPE(select one) DRINKING WATER SOURCE Fli
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In RESIDENTIAL OSS n COMMUNITY OSS n COMMERCIAL OSS h- PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z I_-
TYPE OF WORK(se ect one) 2 PUBLIC WATER SYSTEM t
NEW CONSTRUCTION/UPGRADES 1FT REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR CP I /.
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
*DESIGN FORM(REQUIRED) �1 SEPTIC DESIGN(REQUIRED) BEDROOMS 3 LOT SIZE .22 Acres r0 I
5-WAIVER(S)(IF APPLICABLE) n
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) X
From Belfair, take Northshore rd to Sandhill Rd and go Rt. Take a left on NE Larson Blvd. to
Follow .9 mi , the site is on the left with a marked mail box. Test holes are in the front yard. r
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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)
0 VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTSI CONDITIONS
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RECORD DRAWNG AND INSTALLATION REPORT
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL
IN`'•• �TOR SIGNATURE� �� � DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
l / oz ffl 3/20 673//?o ?
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WESSITE REVISED
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 123315100009- —
A design will be reviewed when 3 conies 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
al 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: II"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG Designer's Name: Jim Zimny
Nancy Ray 360-516-7287
Applicant's Name: Designer's Phone Number: _
Mailing Address: 991 NE Larson Blvd Designer's Address: 7178 WINDFLOWER PL NW
Belfair wa 98524 SEABECK WA 98380
CLEAR FORM
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
IT Gravity ❑Pressure 0 Trench L'Bed ❑ Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals --- -
Number of Bedrooms 3 Schedule/Class 3034
Daily Flow:Operating Capacity 270 gpd Length 25 ft /
Daily Flow:Design Flow 360 gpd / Diameter 4 in
Septic Tank Capacity(working) 1200 gal Number 2
Receiving Soil Type(1-6) 3 / Separation BED ft
Receiving Soil Appl.Rate 0.8 gpd/ Orifices
Required Primary Area 450 ft Total Number of•. ces N/A
::++
Designed Primary Area 450 /, Diameter +,+ in
Designed Reserve Area N/A ft2 ' Spacing %4f I +'t in
Trench/Bed Width 9 ft ' ,• 0,�+ anifold
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Trench/Bed Length 50 ft Sched .' 4s 7..,,F'Z3 ;++
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�.�.. am,...-- .... % + ft
Elevation Measurements �'=•' a� +,
Original Drainfield Area Slope 1 % Diameter in
New Slope,If Altered % z Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation up-slope 24 in Transport Pipe
from Original Grade T3own_slope 24 in /�Schedule/Class 3034
Designed Vertical Separation 36 in / Length 5' ft
Gravelless Chambers Required? 0 Yes 0 No 1'Optiopal Diameter 4�� in
Pump Required? ❑Yes Er No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day N/A
Diff. in Elevation Between Pump&Uppermost Orifice ft Dose quantity gal
Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity (flood) gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump con m •s♦♦e a
Capacity @ Total Pressure Head gpm DT • 'u 714 ' .e 0 Event Counter
Calculated Total Pressure Head __ ft If Timer: Pump on ,Pump off
Comments AUG 9 12n23
MASON COUNTY ENVIRONMENTAL HEALTH
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DESIGN FORM—PAGE TWO Assessor's Parcel Number. 123315100009— —
. Permit Number_ SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
d Test hole locations P' Drainfield orientation and layout Reference depth from original grade:
V Soil logs !g Trench/bed dimensions and g Septic tank
El Property lines critical distances within layout B Drainfield cover
le Existingand proposed wells Fr D-Box/Valve box locations
p p Reference depth from original grade
within 100 ft of property V Septic tank/pump chamber and restrictive strata:
0 Measurements to cuts,banks,and locations ' Laterals,trench/bed,top and
surface water and critical areas iQ( Observation port location bottom
✓ Location and orientation of E1 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption 0 Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
El Location and dimension of lv{ Lateral placement with distance V Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
El Buildings
0 Audible/visual alarm referenced Yes No
0 Direction of slope indicator Lv( Scale of drawing. hown on scale 0 0 Design staked out
E1 Waterlines bar %►,� 0 0 Recorded Notices attached
V Roads,easements,driveways, i r • i. El Waiver(s) attached
parking �I 0 0 Pump curve attached
VI 0 0 Evaluation of failure
PI North arrow and scale drawing sNt,
shown on scale bar ��� t23�334" Non-residential justification
:� 1DESIGNER 0 0 Waste strength
ExPEros:8/171(7 ❑ 0 Flow
DESIGN APP�OVAL
The undersigned designer must be notified rat time of installation VYes 0 No
Signature f esigner Date
The undersigned has reviewed this design on behalf of Mason County Public Health an n iineR OAIE D
compliance with state and local on-s. gulations:
V)/ lXZ 3 AUG 3 1 2023
Environmental Health Specialist ( DagON COUNTY ENVIRONMENTAL NEAL-
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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: V 1/7026
V 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
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Advantage Perc & Design
Ttmely•Reasonab?e•30 Years of Local Experience
Construction Notes for 3 Bedroom Gravity System
Gravity w/graveless chambers (Rock and pipe may be substituted)
Install 2—9'x25' beds .
Use a 3 -4 hole d-box and speed levelers
Install on 1' from existing drainfield.
Install 24"trench depth on low side of trench and maintain 36" of vertical separation
Install level and along contours. �I O VF. `-
Install in dry weather only. AUG 3 ,
2023
Use existing 1200 gallon septic and add risers for pumping and maintenancelASONCQUNTyENViRO
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System designed for typical residential waste strength sewage only. DJA 1.7
System designed for 360 Gallons Per Day
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APPROVED
AUG 3 1 2023
MASON COUNTY ENVRONMENTAL HEALTH
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Expires:8l17: