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HomeMy WebLinkAboutSWG2023-00341 - SWG Application / Design - 8/10/2023 MASON COUNTY 415 N 6TH STREET,SHELT 98 • SHELTON:360 427-9679670, E 400 EXT 400 BELFAIR:360-275-4467, EXT 400 Public Health & Human Services ELMA:360482-5269,EXT400 FAX:360-427-7787 On-Site Sewage System Permit: SWG2023-00341 APPLICANT ROMERO TABITHA Phone: Address: 25338 SE 279TH PL MAPLE VALLEY, WA 98038 OWNER ROMERO TABITHA Phone: Address: 25338 SE 279TH PL MAPLE VALLEY, WA 98038 SEPTIC DESIGNER Richard Bazzell - Caliber Septic Design Phone: 360-509-7900 Address: 165 Tupleo Way POULSBO, WA 98370 Site Address: XXXX W Shelton Valley Rd Primary Parcel Number: 419022100010 Permit Description: 3-bedroom gravity system Permit Submitted Date: 08/10/2023 Permit Issued Date: 08/22/2023 Issued By: David Anderson Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system). Permit Expiration Date: 08/10/2026 (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/onsiteloss-inspection-request.php or call: 360-427-9670, extension 400. OFFICIAL USE ONLY (_.,(L- .1 DATE RECEIVED: 49 x * MASON COUNTY I /2-c --- { ,_.f . COMMUNITY SERVICES AMO RECEIVED: D BY: ` 5�5 RECEIVE CO CI "N 0 IT vq Public Health(Community Health/Environmental Health) Oj,tin, p\ 360.427.9670,ext.400 or 360.275-4467,ext.400 C V - 415 N.Gth Street�Shelton.WA 98584 S`n G /__� —-1O /`/l I O x v V �J �'J\ Z v ON-SITE SEWAGE SYSTEM APPLICATION v D x APPLICANT PHONE I'T1 n I- Tabitha Romero 209-480-7013 Z c MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE g 25338 SE 279th Place Maple Valley WA 98038 CO I SITE ADDRESS-STREET,CITY.ZIP CODE73 0 West Shelton Valley Rd Shelton WA 98584 I NAME OF DESIGNER PHONE Richard Bazzell 360-509-7900 I NAME OF INSTALLER PHONECI I - To Be Determined n/a PERMIT TYPE(select one) DRINKING WATER SOURCE NI C I RESIDENTIAL OSS COMMUNITY OSS In!COMMERCIAL OSS g PRIVATE INDIVIDUAL WELL 1 PRIVATE TWO-PARTY WELL Z (� TYPE OF WORK(select one) a PUBLIC WATER SYSTEM I f NEW CONSTRUCTION/UPGRADES E.,REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I (� SUBMITTALS 0 SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINE L`'l' 1^ DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE CO ,SWAIVER(S)(IF APPLICABLE) 3 6.52 acres ° DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) See directions on Sheet 1 (SD1) of the attached design. Please note the site is flagged with I n the applicant last name at the road right-of-way. r o 10 I'— SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I l;' OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) 0 VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS Tlf� : 0—SS�t 62, i Carnvackbofrewet4t7 w'/ fit ' 35 'c grOve ( 7(fL , 0 -56'' (75C . C60)(pQ(f•ov)1r( b w( ''tt Pac( of iliq' Crrnpacbpi RECORD DRAWING 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. INS° TOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE 57 l/zcz3 f/(O/zoz6 ?I zz/ 0�3 ,1 ,,_ THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/ 5 DESIGN FORM-PAGE ONE Assessor's Parcel Number: -- -- 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 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: SWG Designer's Name: Richard Bazzell Applicant's Name: Tabitha Romero Designer's Phone Number: 360-509-7900 Mailing Address: 25338 SE 279th Place Designer's Address: 165 NW Tupelo Way Maple Valley WA 98038 Poulsbo WA 98370 City State Zi• Ci State Zi• Mik4VJ k...,x.{I �$*.... .,,',�s`...MdT._$r'.fi.,ME.n�c i°� - . _ . .. ., `z4i. ?s., 7'� 'Y:v4 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 L"Gravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip Septic Tank/Drainfield Specifications / Laterals Number of Bedrooms 3 Schedule/Class 40/3034 Daily Flow:Operating Capacity 270 gd /Length 40 ft Daily Flow:Design Flow 360 gpd Diameter 4 it✓ Septic Tank Capacity(working) 1250 gal Number 5 / Receiving Soil Type(1-6) 4 V eparation 10 on-center tt// Receiving Soil Appl. Rate 0.6 gpd/f Orifices Required Primary Area 600 ft2 Total Number of Orifices n/a Designed Primary Area 600 ft2 Diameter n/a in Designed Reserve Area 600 ft2 Spacing n/a in Trench/Bed /Width 3 ft `' Manifold Trench/Bed Length 40 ft,-7 Schedule/Class DBOX Elevation Measurements Length n/a ft Original Drainfield Area Slope 5-7 % Diameter n/a in New Slope,If Altered n/a % Preferred manifold configuration used? 0 Yes 0 No Depth of Excavation Up-slope 17.2-19.2 in Transport Pipe from Original Grade Down-slope 15-19 in Schedule/Class 40/3034 Designed Vertical Separation 36 in Length 55-65 ft Gravelless Chambers Required? 0 Yes 0 No l'Optional Diameter 4 in Pump Required? 0 Yes er No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day n/a Diff.in Elevation Between Pump&Uppermost Orifice n/a ft Dose quantity n/a gal Drainfield Squirt Height/Selected Residual(head) n/a ft Chamber Capacity flood gal Uppermost Orifice 0 Higher 0 Lower than PumpShutoff Pump controls '!eiru Capacity @ Total Pressure Head n/a gpm ❑Timer ❑Ela se Meter 0 Event Counter Calculated Total Pressure Head n/a ft If Timer: Pump on AUQ/li L 2O ump off n/a Comments NT�L HEALTH A site evaluation was completed on 08/01/2023 with Mason C Nl1t g ti€N a� i. For questions or comments regarding the site evaluation and/or this design please see Day- A nderson. DESIGN FORM—PAGE TWO Assessor's Parcel Number: -- -- Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch El Test hole locations 10 Drainfield orientation and layout Reference depth from original grade: P1 Soil logs 0 Trench/bed dimensions and L( Septic tank O Property lines critical distances within layout le Drainfield cover O Existing and proposed wells Er D-Box/Valve box locations Reference depth from original grade within 100 ft of property 0 Septic tank/pump chamber and restrictive strata: ❑ Measurements to cuts,banks, and locations 1a Laterals,trench/bed,top and surface water and critical areas Er Observation port location bottom ❑ Location and orientation of 10 Clean-out location 0 Curtain drain collector curtain drain and all absorption 0 Manifold placement 0 Sand augmentation components 0 Orifice placement Other cross-section detail: Ef Location and dimension of 0 Lateral placement with distance 0 Observation ports/clean-outs primary system and reserve area to edge of bed Er Buildings g Other Information 0 Audible/visual alarm referenced Yes No O Direction of slope indicator 0 Scale of drawing shown on scale 1°1 ❑ Design staked out O Waterlines bar 0 al Recorded Notices attached 0 Roads, easements,driveways, 0 GI Waiver(s)attached parking 0 Gi Pump curve attached O North arrow and scale drawing 0 G?Evaluation of failure shown on scale bar Non-residential justification ❑ 0 Waste strength 7 0 L(Flow DESIGN AP 4 V' • 0 <� itN/ The undersigned designer must be notified by installer at t. f inst=' 'o ion 0 Yes 0 No / Signa i a of Design r'''\0 J 0 / Date The undersigned has reviewed this design on beha, y 21037t� t c Are AROQIEe, ealth and compliance with state and local on-s. egulatio i►IF LICENSED DESIGNER Aio ..om.............t, AUG 1 2 2023 Environmental Health Specia st Da I. ' COUNTY ENVIRONMENTAL HEALTI DJA 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: w/g/go76" ✓ 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 _ CO ----.1 Cr) cn A c, D...) 0 (_T, A W N -_, c3 .. Q g -pn �. �z -Ic -r � 3 03 o w K 5' D m 7- 3• (Da cp = n"�i c D D C. 0 vci o o to co a c m = m CD N a N _ N a 73 o co cD, cD 7 m m p o_ a N co 0 m N 730 o u, cn w a CD °' m D C7 CD 7 N 0- N. n y c 3 O c7' CD fl- a CCDD C-, Cit D Ca. 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