HomeMy WebLinkAboutSWG2022-00566 - SWG Application / Design - 11/8/2022 (2) MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
• SHELTON:360427-9670,EXT 400
BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2022-00566
APPLICANT MANLEY TRUST JULIE MAE Phone: 1.360.877.2750
Address: JULIE MAE MANLEY TRSE HOODSPORT, WA 98548
OWNER MANLEY TRUST JULIE MAE Phone: 1.360.877.2750
Address: JULIE MAE MANLEY TRSE HOODSPORT, WA 98548
SEPTIC DESIGNER DALE TAHJA-Septic Designer Phone: 360-426-5940
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
SEPTIC INSTALLER TJ Goos-TJ's Excavating Phone: 360-490-0217
Address: 150 E MARISA PL SHELTON, WA 98584
Site Address: 250 E Big Skookum Rd
Primary Parcel Number: 220207590090
Permit Description: New 4bd ATU to Oscar II
Permit Submitted Date: 11/08/2022
Permit Issued Date: 12/12/2022
Issued By: Rhonda Thompson
Current Permit Fees Paid: $900.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 11/28/2025 (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.
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COMMUNITY SERVICES "" j _ �- ' m co
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415 N.6th Street-Shelton.WA 98584 S A'G � �� - � ��J N_ T
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ON-SITE SEWAGE SYSTEM APPLICATION z
APPLICANT PHONE m
Julie Manley 1 (912) 844-2744 z
MAILING ADDRESS-STREET,CITY, c STATE,ZIP CODE C
143 N. Mt. Washington Dr. Hoodsport WA 98548 m
SITE ADDRESS-STREET,CITY,ZIP CODE
250 E. Big Skookum Rd. Shelton WA 98584 IN)
NAME OF DESIGNER PHONE N
Dale L. Tahja (360) 426-5940 I
NAME OF INSTALLER PHONE 0 I C)
T.J. Goos (360) 490-0217 z N
PERMIT TYPE(select one) DRINKING WATER SOURCE O
g RESIDENTIAL OSS 5-COMMUNITY OSS COMMERCIAL OSS lir PRIVATE INDIVIDUAL WELL 15 PRIVATE TWO-PARTY WELL Z I c)
TYPE OF WORK(select one)
PUBLIC WATER SYSTEM r
W NEW CONSTRUCTION/UPGRADES 5REPAIR/REPLACEMENT OTHER DETAILS(select ell that apply) 0 TABLE IX REPAIR I �1
SUBMITTALS 0 SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINE
co
DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE 0 I (xi
5-WAIVER(S)(IF APPLICABLE) 2.84 acres 0 -
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DIRECONS T-0 SITE AND SITE CONDITIONS:(ex.locked gate) N.
Go out Agate Rd., past Timber Lake, right on Benson Lp", s y rigVVVht,, rig1t1ht on Big Skookum I o
Rd., • -perry on the right. Rope across driv- a niocked.
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• E MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE- GGED WITH TEST HOLE NUMBERS. I
OFFICIAL USE ONLY BELOW THIS LINE
V UPGRADE/FAILURE SOURCE(for mptxtlng purposes)
: 0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE OCOMPLAINT ❑OTHER: � i Ar
INSPECTOR SOfL LOGS COMMENTS/CONDITIONS •'`7 _,{'
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, RECORD DRAWING AND INSTALLATION REP- sue.{
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE CATION APPROVED/ISSUED BY - TE
DATEDA
11�2��ZZ t‘`2�1Z� q"il'v">
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 0 2 0 — 7 5 — 9 0 0 9 0
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: SWG 2022-00566 Designer's Name: Dale Tahja
Applicant's Name: Julie Manley Designer's Phone Number: (360)426-5940
Mailing Address: 143 N. Mt.Washington Dr. Designer's Address: 2450 W Deegan Rd W
Hoodsport WA 98548 Shelton WA 98584
City State Zip City State Zip
k . _ DESIGN PARAMETERS
Treatment Device
0 Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
[Aerobic Unit Make/Model NuWater BNR 500 ❑Disinfection Unit Make/Model Other:
Drainfield Type
❑ Gravity g Pressure 0 Trench l'Bed 11Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class OS-100 coils
Daily Flow:Operating Capacity 270 gpd Length 7X7 ft
Daily Flow: Design Flow 360 gpd Diameter Netafim Bioline in
Septic Tank Capacity(working) 1,000 gal Number 4
Receiving Soil Type(1-6) 5 Separation 1 ft
Receiving Soil Appl. Rate 0.4 gpd/ft2 Orifices
Required Primary Area 900 ft2 Total Number of Orifices 400 emitters
Designed Primary Area 900 ft2 Diameter Netafim Emitters in
Designed Reserve Area 900 ft2 Spacing 100 emitters/coil in
Trench/Bed Width 30 ft Manifold
Trench/Bed Length 30 ft Schedule/Class Sch. 40
Elevation Measurements Length 60 ft
Original Drainfield Area Slope 3 % Diameter 1 in
New Slope,If Altered 1 % Preferred manifold configuration used? 0 Yes lif No
Depth of Excavation Up-slope 3 in Transport Pipe
from Original Grade Down-slope 1 in Schedule/Class Sch. 40
Designed Vertical Separation 12 in Length 150 ft
Gravelless Chambers Required? 0 Yes El No 0 Optional Diameter 1 in
Pump Required? 64 Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 360
Dif , in Elevation Between Pump&Uppermost Orifice 5 ft Dose quantity 1.03 gal
Drainfield Squirt Height/Selected Residual(head) drip ft Chamber Capacity(flood) 1,000 gal
Uppermost Orifice rif Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 12 gpm It 'Timer lifElapse Meter Gil Event Counter
Calculated Total Pressure Head 18 ft If Timer: Pu n ,vnE min. 38 sec.
Comments
SEP 1 1 2023
MASON COUNTY ENVIRQNMENrai HALTµ
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DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 2 0 2 0 — 7 5 — 9 0 0 9 0
Permit Number: SWG 2022-00566
DGN CHECKLISTS:.
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
El Test hole locations 121 Drainfield orientation and layout Reference depth from original grade:
6ii Soil logs Et Trench/bed dimensions and gi Septic tank
lii Property lines critical distances within layout 121 Drainfield cover
66 Existing and proposed wells RI D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 6t Septic tank/pump chamber and restrictive strata:
66 Measurements to cuts,banks, and locations 611 Laterals,trench/bed,top and
surface water and critical areas 66 Observation port location bottom
66 Location and orientation of 6t1 Clean-out location 0 Curtain drain collector
curtain drain and all absorption Eil Manifold placement G7! Sand augmentation
components 66 Orifice placement Other cross-section detail:
6Z1 Location and dimension of Et Lateral placement with distance 6Z1Observation ports/clean-outs
9 primary system and reserve area to edge of bed Other Information
66 Buildings Et Audible/visual alarm referenced Yes No
fig Direction of slope indicator lii Scale of drawing shown on scale w 0 Design staked out
6 Waterlines bar 0 0 Recorded Notices attached
66 Roads,easements,driveways, 0 0 Waiver(s)attached
parking Q( 0 Pump curve attached
6d North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑ Flow
DESIGN.APPROVAL
The undersigned designer must be n tified ins at time of installation lt Yes 0 No
Signature of Designer Date �.• �` ,
g �401" c? ' .1 i
The undersigned has reviewed thi 4 esign on behalf of Mason County Public Health and dete •' • n<V
compliance with state and local •. •ite regulations: r C.
a'it"V`
\fri51...,, Ct--4-2") '1/4
vir n Health Specialist Date Sk (b '- Q'
CAUTION: DESIGN APPR•VAL IS VALID ONLY UNDER THE FOLLOWING COND v,11 y-«')
✓ The design is stamped"Approved"by Mason County Public Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: t /
✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval. : 4
Please Note: The system must be installed by a certified installer,
unless prior authorization is obtained from Maso r : pinPobilth.
An Installation Fee is required.
• w� 5kN 1 1 2023
This form may be scanned and available for public view on the Mason COtiiikiligibiki0MENTAL HEALTH
J sated Date: 12/7/2015
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