HomeMy WebLinkAboutSWG2023-00331 - SWG Application / Design - 8/8/2023 / 415 N 6TH STREET,SHELTON,WA 98584
MASON COUNTY SHSTREE ,S 42TON, 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: SWG2023-00331
APPLICANT KNOPF ERIC & POPPY Phone: 360-509-4436
Address: PO BOX 163 POULSBO, WA 98370
OWNER KNOPF ERIC & POPPY Phone: 360-509-4436
Address: PO BOX 163 POULSBO, WA 98370
SEPTIC DESIGNER KNOPF ERIC & POPPY Phone: 360-509-4436
Address: PO BOX 163 POULSBO, WA 98370
Site Address: XXX E Sherwood Rd
Primary Parcel Number: 122307590022
Permit Description: 3-bedroom pump to gravity
Permit Submitted Date: 08/08/2023
Permit Issued Date: 09/05/2023
Issued By: David Anderson
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 08/08/2026 (based on date of inspection)
Permit Conditions:
'i 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.
OFFICIAL USE ONLY-
DATE RECEIVED: � - (^ - ��r-��
_, ► ASON COUNTY
7,, • •MMUNITY SERVICES AMOUNT D C� RECEIVID6 CO N
_ _ , ' �x5 �JJ < cn
Publf Health(Community Health/Environmental Heath) � N O
!n,,.,n''`1.i36o4z7'67..et•Shan,WA9�467,ex1.400 SWG 3 - 0G23 x
4,sn e� sn«o�Shelton, 5
PSG ' Z y
17
BCK'-\NO ON-SITE SEWAGE SYSTEM APPLICATION m n
APPLICANT m
PHONE
Eric Knopf 360-509-4436 z
3
MAILING ADDRESS-STREET.CITY,STATE.ZIP CODE 3
PO Box 163, Poulsbo, WA 98370 co
SITE ADDRESS-STREET,CITY,ZIP CODE 1
Lot B, Sherwood Heights Road
NAME OF DESIGNER PHONE 1 N
Eric Knopf 360-779-5233 I
N
PHONE ID
NAME OF INSTALLER
N IW
PERMIT TYPE(select . DRINKING WATER SOURCE O
k(RESIDENTIAL U:. " COMMUNITY OSS 5 COMMERCIAL OSS 'PRIVATE INDIVIDUAL WELL b PRIVATE TWO-PARTY WELL Z
aPUBLIC WATER SYSTEM 1
TYPE OF WORK(select one)W'NEW CONSTRUCTION/Ur-GRADES �'REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) CITABLE IX REPAIR I 1
El SURFACING SEWAGE El EXISTING FAILURE 0 SHORELINE 03
SUBMITTALS
DESIGN FORM(REQUIRED) 01 SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE 0 1 Ul
WAIVER(S)(IF APPLICABLE) 3 140984 sq ft 0 I i
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
We will need to meet on site because it is a drainfield easement on
the neighbor's property and I'll need to fill in the soils logs after 6 I CD
assessment. Please see attached directions to lot. 1 N
IN
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS.
- -- OFFICIAL USE ONLY BELOW THIS LINE -
UPGRADE I FAILURE SOURCE((or reporting purposes)
0 VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ❑COMPLAINT 0 OTHER:
COMMENTS/CONDITIONS
INSPECTOR SOIL LOGS � O ���
TR1 : a— SI `'bV(1frS / p20
35/o y fave,(
,r(i: 0-53' 67 L FS L✓10 Mortio4 o
Poceerfs at S%If(c(ux _ a
TN3: 0- S1k' 6i,F5 W/o re5117 ien w
POC161415 c f yraue( CypQC 'i
z4
RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES: REQUIRED FOR FINAL APPROVAL.
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS DATE
DATE APPLICATION EXPIRATION DATE APPLICATI PPROVED'ISSUED BY
INSPE• ••' SIGNATURE Y�5I ��Pf/ Z3 m( z6
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE
REVISED 127/2015
DESIGN FORM-PAGE ONE
Assessor's Parcel Number: 1 2 2 3 O -- 7 _ — 9092, I-
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. .'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: S G _ Designer's Name:
Eric Knopf
Eric Knopf 360-509-4436
• ••licant's Name: Designer's Phone Number:
PO Box 163
Mailin k-:N • PO Box 163 Designer's Address:
'oulsbo, WA 98 Poulsbo, WA 9837
AUG ? 4 ZOZ3 City State Lip City State Zip
DESIGN PARAMETERS
iilECE/vED Treatment Device
❑Glendon Bt - 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make Model
❑Disinfection Unit MakeModel Other:
Drainfield Type
�/ 0 Pressure 19'Trench 0 Bed 0 Sub Surface Drip
19 Gra�'1C}'
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 / Schedule/Class 3034 360 gpe .�
i'
Daily Flow:Operating Capacity 360 gpd/ Diameter 4
Length 50 ft in7
Daily Flow: Design Flow Septic Tank Capacity(working) 1 500 gal Number ,'
Receiving Soil Type(1-6) /
4 / Separation 2 ft
Receiving Soil Appl.Rate .6 gPd/ 2 Orifices 3034 drainpipE
Required Primary Area 600 ft' Total Number of Orifices
Designed Primary Area
600 ft'` Diameter in
Designed Reserve Area 2150 ft- Spacing in
TrenchBed Width 3 ft/ Manifold
Trench/Bed Length
50 ft --' Schedule/Class D-box
Elevation Measurements Length ft
Original Drainfield Area Slope
3 % Diameter t
New Slope,If Altered °/o Preferred manifold configuration used? 0 Yes 0 No
1
Depth of Excavation Up-slope2 in Transport Pipe
from Original Grade Down-slope 1 2 in Schedule/Class 40 /
/
/ Length 450 ft
Designed Vertical Separation 36 in 2
in
Gravelless Chambers Required? ❑ Yes It No 0 Optional Diameter
Pump Required? P'Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses.fday 6 (
59.5
20 ft Dose quantity gal
Diff. in Elevation Between Pump&Uppermost Orifice 1000
Drainfield Squirt Height/Selected Residual(head)
5ft Chamber Capacity(flood) gal /
Pump controls: Please check those required.
Uppermost Orifice Er Higher 0 Lower tha$P p Shutoff
Capacity(d:Total Pressure Head O•b gpm 'Timer littlapse Meter 4v nrst C unte/
Calculated Total Pressure Head
35 ft If Timer: Pump on 7min ,Pump off
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number: I2230 _ 7.5 _- 9aozz
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
N0 T• est hole locations IiEl Drainfield orientation and layout Reference depth from original grade:
Soil logs 'El Trench/bed dimensions and 1 Septic tank
\EI P• roperty lines
critical distances within layout \EI Drainfield cover
\Ca D-Box/Valve box locations Reference depth from original grade
within 100 ft of property
�l7 Existing and proposed wells Ng Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts,banks,and locations 1 Laterals,trench/bed,top and
surface water and critical areas ' l Observation port location 0bottom
Curtain drain collector
❑ Location and orientation of NU Clean-out location CI Sand augmentation
curtain drain and all absorption 0 Manifold placement
components 0 Orifice placement Other cross-section detail:
'El Location and dimension of `Cil Observation ports/clean-outs
NU Lateral placement with distance
primary system and reserve area to edge of bed Other Information
Buildings 19 Audible/visual alarm referenced Yes No
\l?l Direction of slope indicator I9 Scale of drawing shown on scale 0 0 Design staked out
0 0 Recorded Notices attached
�77 Waterlines bar 0 0 Waiver(s)attached
�tl Roads,easements,driveways, ] El curve attached
parking ❑ ❑ Evaluation of failure
1Q] North arrow and scale drawing Non-residential justification
shown on scale bar
❑ 0 Waste strength
Cl ❑Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer at t.me of installation NI Yes ❑ No
^ �� 7-�7-23
Signature o Designer Date/A p ey
t
The undersigned has reviewed this design on behalf of Mason County Public Health and determine it o b-in
compliance with state and local ono egulations: SEP a 5 20 .;
1/i 7(;/ZO 71 MASO
LT
Environmental Health Specialist DJA W
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. V/g/
��.JC✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: C/ 6
✓ 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.dated Date: 12/7/2015
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• • GLIENT:
ERIC KNOPF
CONTROL
PANEL TAX P. #
0 12230-75-90022
il;l,i SITE ADDRESS:
'
CONTINUOUS CONDUIT 1:1;1:;I;1
TO PUMP JUNCTION BOX LOT B
;;1�1;1;1
I,i,1,1,1 SP 2650
{1,1 I 1!1t
1111'1'I
SHERWOOD HEIGHTS ROAD
I,1 !,1 1
4'X8- TREATED POST ::;';:j';
::::::::: T ID:
1'111 E 201
I,I;1,1,1 ^Y �I
1 1 1 1 1
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I;I;i;1;I
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POURED CONCRETE :,':;I:1: 7'
;I'1'1'1'1
II
FINAL GRADE I'1'I 1'I 1'i
, , ?
I111I ♦
1'111'1'I I
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1
.'.: - INDIGO
:;.�.:; ��`-• DESIGN INC.NOTES
1. LOCATE CONTROL PANEL WITHIN VIEW OF w ^� P.O. BOX 163
/�.�f-+ ®��®OULSBO. —779—TON 98370
1 PUMP TANK ACCESS LID. 360-779-5233
2. CONTROL PANEL MAY ALSO BE INSTALLED
ON EXTERIOR WALL IF INSULATORS ARE
USED TO DAMPEN POSSIBLE MOTOR SEP 0 5 2023
CONTACTOR NOISE. MASON COUNTY ENVIRONMENTAL HEALTH
3. INSTALL CONTROL PANEL IN AN EASILY e11
ACCESSIBLE AND SHADY AREA (IF DJA �� �I
POSSIBLE) TO AVOID TEMPERATURE •04`•` '�'1
EXTREMES WHICH CAN BE DETRIMENTAL 0-. �4$
i�4'' 9�t►
TO ELECTRICAL COMPONENTS. %3�7.od I.
/ •.y,
CONTROL PANEL MODEL SPECIFIED: 0A—•• h �1.> _':�111
0/• , ��1
ORENCO� MVP SIMPLEX ar
%r2•. Eric 50132 10
f ��`/
or
P R '+/
EXPIRES 10-14-24
OCOkTOL
PANEL (TY )
(N.T.S.)
91EET# g OF g SIIFFTS
aiENr:
ERIC KNOPF
CONTROL
PANEL TAX P. #
° 12230-75-90022
SITE ADDRESS:
CONTINUOUS CONDUIT
TO PUMP JUNCTION BOX LOT B
SP 2650
SHERWOOD HEIGHTS ROAD
4"X8" TREATED POST
4"x 8" minimum 0 ID:
4 E-201
NI
POURED CONCRETE 7
FINAL GRADE
_ ,
INDIGO
\OTES :" DESIGN INC.
1. LOCATE CONTROL PANEL WITHIN VIEW OF P.O. BOX 163
GTON
PUMP TANK ACCESS LID. Pouuseo60 77e 5233 98370
2. CONTROL PANEL MAY ALSO BE INSTALLED APPROVED
ON EXTERIOR WALL IF INSULATORS ARE
USED TO DAMPEN POSSIBLE MOTOR
CONTACTOR NOISE. SEP 0 5 2023
3. INSTALL CONTROL PANEL IN AN EASILY .y11, /
ACCESSIBLE AND SHADY AREA (IF MASON COUNTY ENVIRONMENTAL HEALTI or 1
POSSIBLE) TO AVOID TEMPERATURE `u. •
EXTREMES WHICH CAN BE DETRIMENTAL DJA ram? �4^►0
TO ELECTRICAL COMPONENTS. y ^ y.4 0
CONTROL PANEL MODEL SPECIFIED: •�'
jrS te' Z•s,,/!
..�' / .4\I
ORENCO'=' MVP SIMPLEX ir ?• Eric 0Kno f 3 0,
of or
P 1
i R /
momihmieuomilawinimwoomui
EXPIRES 10-14-24
0 CO\TOL PANEL
(N.T.s.)
SI EET# 9 2 c- 511FFT5