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HomeMy WebLinkAboutSWG2023-00265 - SWG Application / Design - 6/23/2023- elln, ': 415 N 6TH STREET,SHELTON,WA 98584 MASON COUNTY SHELTON:360-427- ,EXT 400 BELFAIR:360-275-44674467,EXT 400 ---/�� Public Health & Human Services ELMA: 360-482-5269,EXT 400 `f` FAX:360-427-7787 On-Site Sewage System Permit: SWG2023-00265 APPLICANT DELANY KIMBERLY A Phone: 360-280-2660 Address: 4190 E AGATE RD SHELTON, WA 98584 OWNER DELANY KIMBERLY A Phone: 360-280-2660 Address: 4190 E AGATE RD SHELTON, WA 98584 SEPTIC DESIGNER ROD LEFT-Acme Design Phone: 360-698-8488 Address: PO Box 2954 SILVERDALE, WA 98383 Site Address: 121 E LIZZY LN Primary Parcel Number: 320242290012 Permit Description: New 4bd OscarXO2 Permit Submitted Date: 06/23/2023 Permit Issued Date: 09/11/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $685.00 (additional fees may be required upon installation of system). Permit Expiration Date: 06/29/2026 (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. 7 No clearing of vegetation or addition of impervious surface is permitted within the wetland buffer. 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 RECENEO MASON COUNTY /;15 /P-Oe;-4. _ cn ICIP '_ COMMUNITY SERVICES AMOUNT RECEIVED: I RECEIVED BY: C cn CO _ �Lyy., 5 25 - cn Public Health(Community Health/Environmental Health) '(� C > Street• oa� SWG gj�.3 —0 0 a-65 En o cn --- aisR.6mweec sl�notiwA9esea z (n ON-SITE SEWAGE SYSTEM APPLICATION z m APPLICANT PHONE m I— Falynn Auston & Kim Delany z MAILING ADDRESS-STREET,CITY STATE,ZIP CODE tI ��jl``., K 2002 45th St Ct NW %S�v Gig Harbor WA 98335 co SITE ADDRESS-STREET,CITY,ZIP CODE O np23 �) 121 E. Lizzy Lane .0N ` a helton WA 98584 I CA) NAME OF DESIGNER PHONE I N Rod Left ._ ....---' 360-698-8488 NAME OF INSTALLER el PHONE0 I C) cn I N PERMIT TYPE(select one) ��;; DRINKING WATER SOURCE ERESIDENTIAL OSS COMMUNITY OSS �_IICOMMERCIAL OSS EPRIVATE INDIVIDUAL WELL El PRIVATE TWO-PARTY WELL O I Hj TYPE OF WORK(sebct one) S PUBLIC WATER SYSTEM Agate Grocery wisri NEW CONSTRUCTION/UPGRADES 5 REPAIR/REPLACEMENT OTHER DETAILS(se/ed all that apply) 0 TABLE IX REPAIR I N SUBMITTALSq�. � ❑ SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINECa Lq.;DESIGN FORM(REQUIRED) WISEPTIC DESIGN(REQUIRED) BEDROOMS if ` LOT SIZE a I N 5]WAIVER(S)(IF APPLICABLE) �/ / 64,904 n I up DIRECTIONS TO SITE ANO SITE CONDITIONS:(ex.locked gate) ic) -I I ( - SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I N OFFICIAL USE ONLY BELOW THIS LINE UPGRADE I FAILURE SOURCE(for reoorUng purposes) 0 VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ❑COMPLAINT 0 OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS \ Z- D - mW ,tv\bd - Stuti (u\ -t l) 0--- 1"3 : o 1 Z &Lr i Y\k.oa -A-Iktyt-t,.4„ \z-r ' 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. INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE 1 ,'VW1 (42,St j1/3 ((2 at 12& 1/11 / 1(L h,3 THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12T7/2015 I. Ric- I s il,‘ ' IYESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 0 2 4 — 2 2 — 9 0 0 1 2 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 1 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" `Is iY Hq . 4,k';A 1. w..;:a7t *. '�' y ..N X -e�, -6x ${'r . y s `i "s�aid';^� "YAt;fz4 :rz [,� ,.fit .b�':�F,t �"3 r��.ra... ..-°�;x..� A is..::, ..,,.�..:.rm.i.:.� �s�- '�, r ��,�'v£nM. <-": ?..L�K.�. ..i;�.c..... !`",{.r.ws_. Permit Number: SWG Designer's Name: Rod Left Applicant's Name: Falynn Auston&Kim Delany Designer's Phone Number: 360"�$" $ Mailing Address: 2002 45th St Ct NW Designer's Address: PO Box 2954 Gig Harbor WA 98=4:15 Silverdale WA 98383 City State Zip City State Zip Treatment Device ❑Glendon Biofilter ❑Sand Filter g Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type: lifAerobic Unit Make/Model OSCar X02 0 Disinfection Unit Make/Model Other: Drainfield Type 0 Gravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip Septic Tank/Drainfield Specifications . Laterals Number of Bedrooms 4 Schedule/Class XC,2— Daily Flow:Operating Capacity 360 gpd Length $ ()5—50 ft Daily Flow:Design Flow 480 gpd Diameter C 641 s in Septic Tank Capacity 1500 gal Number Receiving Soil Type(1-6) 5 Separation ft Receiving Soil Appl.Rate 0.4 gpd/ft2 Orifices Required Primary Area 1200 ft2 Total Number of Orifices Designed Primary Area 1200 ft2 Diameter in Designed Reserve Area 1200 ft2 Spacing in Trench/Bed Width 18 ft Manifold Trench/Bed Length 66.66 ft Schedule/Class Elevation Measurements Length ft Original Drainfield Area Slope 2 % Diameter in New Slope,If Altered 2 % Preferred manifold configuration used? 0 Yes 0 No Depth of Excavation Up-slope N/A in Transport Pipe from Original Grade Down-slope N/A in Schedule/Class 40 Designed Vertical Separation 124. in Length 60 ft Gravelless Chambers Required? 0 Yes id No 0 Optional Diameter 1 in Pump Required? lif Yes 0 No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day Pre-set Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity gal Orifice 2 ft Chamber Capacity WOO 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 30 sec ,pump off 3 min Comments DESIGN FORM—PAGE TWO Assessor's Parcel Number:3 2 0 2 4 -- 2 2 -- 9 0 0 1 2 Permit Number. SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch El Test hole locations Drainfield orientation and layout Reference depth from original grade: Pi Soil logs Ei Trench/bed dimensions and Septic tank E0 Property lines critical distances within layout Drainfield cover O Existingand proposed wells D-Boxalve box locations P P /V Reference depth from original grade within 100 ft of property lid Septic tank/pump chamber and restrictive strata: • Measurements to cuts,banks,and locations E4 Laterals,trench/bed,top and surface water and critical areas Ig Observation port location bottom ❑ Location and orientation of Pi Clean-out location 0 Curtain drain collector curtain drain and all absorption ❑ Manifold placement 0 Sand augmentation components 0 Orifice placement Other cross-section detail: • Location and dimension of Lateral placement with distance 0 Observation ports/clean-outs primary system and reserve area to edge of bed Buildings Other Information Audible/visual alarm referenced Yes No • Direction of slope indicator Scale of drawing shown on scale 0 d Design staked out I1 Waterlines bar 0 El Recorded Notices attached E6 Roads,easements,driveways, 0 Cif Waiver(s)attached parking ❑ CI Pump curve attached 6Q North arrow and scale drawing 0 Ig Evaluation of failure shown on scale bar Non-residential justification ❑ ❑Waste strength ❑ ❑Flow DESIGN APPROVAL The undersigned designer must be notified by ins ler at ins ation Yes 0 No Si of Designer Date The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in compliance with state and local on-site regulations: p.,--NNAlvvp(04-1 ckIl � fZ3 Environmental Health SpeciaTist Date CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: •✓ The design is stamped"Approved"by Mason County Public Health. p (2i/z- /✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: �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 Mason County WA GIS Web Map 1i i l _ -- East - - { East __....._ _- ---- I TV CD APP .- OVED SE' 1 1 2023 • MASON COUNTY NVIRONMENTAL HEALT.I . 1 RET / �— — r, 1 -7 / �— !• -FL1.C.. 8/11/2023, 8:35:21 AM 1:3,072 0 0.03 0.05 0.1 mi D County Boundary I I r 1 f + r r 0 0.04 0.08 0.16 km 0 No Filled Tax Parcels (Zoom in to 1:30,000) O OpenStreetMap(and)contributors,CC-BY-SA Mason County WA GIS Web Mao Application Map data O OpenStreetMap contributors,CC-BY-SA i I (n Q(n W (I)Q.(/) (/) (/)Q(/) (/) o ��O O Z - . ��o 0 T o o u m > � n o o o z o 0 O) — N PmmDDXrA AmCOAA� N r 0° r CD.- r 11m - 10 Oom � mn0 {mN{ �, Q g - o 0 o • Dmmo � m � < mOZ � Omzp) i D AQ Omm >0 • * 0mm m � Oz � A � r0 ; � 00C0 NZZI r ril � Dp.. 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