HomeMy WebLinkAboutSWG2023-00320 - SWG Application / Design - 8/3/2023 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: SWG2023-00320
APPLICANT Merlene & Kent Cobb Phone:
Address: 705 Naval Ave BREMERTON, WA 98312
OWNER GUSTAFSON KATRINA Phone: 1.360.463.6979
Address: 20 E SNOWCREST LN SHELTON, WA 98584
SEPTIC DESIGNER DALE TAHJA-Septic Designer Phone: 360-426-5940
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: 1041 E Sunset Hill Rd
Primary Parcel Number: 221341102010
Permit Description: New 2BR SFR -Gravity w/class b waiver
Permit Submitted Date: 08/03/2023
Permit Issued Date: 09/11/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $780.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 08/22/2026 (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.
OFFICIAL USE ONLY ��
MASONCOUNTY DATE RECEIVED-. 8'3` Z3
COMMUNITY SERVICES AMVt RECEIV W CA
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Public Health(Community Health/Environmental Health) Cl)Ccn
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366417-9670,ext.400 or360 27s-0467,ext.400 S W G :V Zia-- 603 o 2
415 116th Street-Shelton,WA 985844Z di
ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT PHONE m m
Merlene & Kent Cobb (360) 907-3105 c
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE 3
705 Naval Ave. Bremerton WA 98312 m
SITE ADDRESS-STREET,CITY,ZIP CODE '
1041 E. Sunset Hill Rd. Shelton WA 98584 s"
NAME OF DESIGNER PHONE I N
Dale L. Tahja (360) 426-5940
NAME OF INSTALLER PHONE • I
T.J. Goos (360) 490-0217
z, I (A)PERMIT TYPE(select one) DRINKING WATER SOURCE O
4 II!URMp RESIDENTIAL OSS COMMUNITY OSS COMMERCIAL OSS El(.PRIVATE INDIVIDUAL WELL f PRIVATE TWO-PARTY WELL Z 41.
TYPE OF WORK(select one) F-!PUBLIC WATER SYSTEM
I i+NEW CONSTRUCTION I UPGRADES ffREPAIR/REPLACEMENT OTHER DETAILS(select all that apply) ❑ TABLE IX REPAIR I
SUBMITTALS VTTALS El SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
CO
1YDESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE O I
gWAIVER(S)(IF APPLICABLE) 2 4.4 acres o I '
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DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate)
Go onto Hartstene Island, turn left onto Hartstene Island Rd, turn left onto Sunset Hill Rd., I N
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property on the left. o I o
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. Will° I 0
--- ------ — OFFICIAL USE ONLY BELOW THIS LINE----
I
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS �OP _A ; i
/2
r v,(5,),_ _ ---,.
,) j_..,131)/j. V l. ,7 G V4) AN, ?,
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RECORD DRAWING AND INSTALLATION REPO y4
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSP CTOR SI TURE DATE APPLICATION EXPIRATION DATE AP ION APPROVED/ISSUED BY DATE
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T F Y BE SCC.ANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12nn015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 1 3 4 — 1 1 — 0 2 0 1 0
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. 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 .�� .^� '- }� U Designer's Name: Dale Tahja
Applicant's Name: Merlene&Kent Cobb Designer's Phone Number: (360)426-5940
Mailing Address: 705 Naval Ave. Designer's Address: 2450 W Deegan Rd W
Bremerton WA 98312 Shelton WA 98584
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: N/A
Drainfield Type
cif Gravity 0 Pressure l 'Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class 3034
Daily Flow:Operating Capacity 180 gpd Length 45 ft
Daily Flow:Design Flow 240 gpd Diameter 4 in
Septic Tank Capacity(working) 1,200 gal Number 3
Receiving Soil Type(1-6) 4 Separation 7 ft
1 Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 400 ft2 Total Number of Orifices Perf. Pipe
Designed Primary Area 400 ft2 Diameter in
Designed Reserve Area 400 ft2 Spacing in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 135 ft Schedule/Class 3034
Elevation Measurements Length 40 ft
Original Drainfield Area Slope 3 % Diameter 4 in
New Slope,If Altered 3 % Preferred manifold configuration used? 0 Yes fi�No
Depth of Excavation Up-slope 22 in V Transport Pipe
from Original Grade Do -scope 21 i Rci2d /4s E 3034
Designed Vertical Separation 24 Letjr
5 ft
Gravelless Chambers Required? 0 Yes 0 No A .
1 2023 4 in
Pump Required? ❑Yes 51No MASON C)UN?Y ENVIRON%1E�JDIpsigand Pump Chamber
Pump/Siphon Specifications Nun1 oses/day Gravity
Duff. 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 controls:Please check those required.
Capacity @ Total Pressure Head gpm ❑Timer ❑Elapse Meter 0 Event Counter
Calculated Total Pressure Head ft if Timer: Pump on ,Pump off
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number:2 2 1 3 4 -- 1 1 -- 0 2 0 1 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
g Test hole locations li?! Drainfield orientation and layout Reference depth from original grade:
EA Soil logs Ell Trench/bed dimensions and Eli Septic tank
lit Property lines critical distances within layout ITlf Drainfield cover
lif Existing and proposed wells 6l1 D-Box/Valve box locations Reference depth from original grade
within 100 ft of property Ei4 Septic tank/pump chamber and restrictive strata:
O Measurements to cuts, banks, and locations Gd Laterals,trench bed,top and
surface water and critical areas 6d Observation port location bottom
121 Location and orientation of 0 Clean-out location 0 Curtain drain collector
curtain drain and all absorption Fil Manifold placement 0 Sand augmentation
components i i Orifice placement Other cross-section detail:
EZI Location and dimension of It Lateral placement with distance C6 Observation ports/clean-outs
primary system and reserve area to ed:e of bed
6d Buildings4 *'� Information
• a `: ed YesOther No
Iii Direction of slope indicator Scale of drawing shown y.ale txi 0 Design staked out
Eid Waterlines bar 112023 ❑ ❑ Recorded Notices attached
10 Roads,easements,driveways, Eli ❑ Waiver(s)attached
parking NON COUNTY ENVIRONMENTAL HEAL', 0 0 Pump curve attached
North arrow and scale drawing J B W ❑ ❑ Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑ Flow
DESIGN APPROVAL
-The undersigned designer st be notifie y ins I rat time of installation It Yes 0 No
Cam \ .72 \ az
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Signature of Designer \ Date +�5,ISC� ,�i
The undersigned has reviewed this design on behalf of Mason County Public Health and det, ' to <3
compliance with state and loc -site,regulations: = ��O'� v Q,N 1
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n �i ental Health Specialist Date n 4- `Zri,- U Q Z ;
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING COND iii.�•�;..• =J;
✓ The design is stamped"Approved"by Mason County Public Health. 1ik 7� .
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: -LZ --)
4(')-
.1/413
✓ 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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APPROVER
SEP -1 1 2023 '' `
•IASON COUNTY ENVIRONMENTAL HEALTH
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1
Installation/Maintenance
Gravity Distribution/Trench Systems
1. Install trench 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. Divert all storm water run-off away from septic system components.
4. No curtain (french) drains allowed within l Oft. of the up-slope edge of the drainfield and
reserve area.
5. No curtain(french) drains allowed within 30ft. of the down-slope edge of the drainfield
and reserve area.
6. Have the septic tank pumped or inspected every 3 to 5 years.
7. All material and workmanship must meet County and State requirements.
8. Install risers on septic tank.
9. Deviation from this approved design without prior approval from the Designer and
Mason County Health Department will make this design null and void.
10.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.
11.Locate all utilities prior to starting installation.
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