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HomeMy WebLinkAboutSWG2023-00315 - SWG Application / Design - 7/28/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 (14,- 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: SWG2023-00315 APPLICANT SHOEMAKER MICHAEL Phone: Address: 2000 MADRONA BEACH RD NW OLYMPIA, WA 98502 OWNER SHOEMAKER MICHAEL Phone: Address: 2000 MADRONA BEACH RD NW OLYMPIA, WA 98502 SEPTIC DESIGNER ROD LEFT -Acme Design Phone: 360-698-8488 Address: PO Box 2954 SILVERDALE, WA 98383 Site Address: 231 E Arellem Rd Primary Parcel Number: 321055100012 Permit Description: New SFR-5BR Gravity w/waiver Permit Submitted Date: 07/28/2023 Permit Issued Date: 09/20/2023 Issued By: Jeff Wilmoth Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system). Permit Expiration Date: 08/28/2026 (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 DATE RECEIVED: MASON COUNTY s = • U) D COMMUNITY SERVICES AMOU t • C VED: RECEIVEDB • I o m Public Health(Community Health/Environmental Health) -- ` _C N 360-427-9670,wt.400 w 360475-4467,ert<00 `//��''' ) 0 I 0 415 N.6e+Street•Shelton,WA 99584 S W VJ -0 • _ , l Q /xl r fir. Z In ON-SITE SEWAGE SYSTEM APPLICATION g Al m n APHLICANT PHONE m (— Michael Shoemaker Z MAILING ADDRESS-STREET.CITY.STATE.ZIP CODE \\614 11th Ave SE G t \�1co `J Olympia WA 98501m SITE ADDRESS-STREET,CITY.ZIP CODE D �� n il 023k. E. Arellem Rd J _rj Union WA 98592 NAME OF DESIGNER \ PHONE I N Rod Left cm360-698-8488 NAME OF INSTALLER PHONE I j 0 O PERMIT TYPE(select one) DRINKING WATER SOURCE O fir RESIDENTIAL OSS E.COMMUNITY OSS COMMERCIAL OSS U0 INq PRIVATE INDIVIDUAL WELL E.PRIVATE TWO-PARTY WELL Z I C 1 TYPE OF WORK(select one) PUBLIC WATER SYSTEM —_ I NEW CONSTRUCTION/UPGRADES 6 REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I Ul SUBMITTALS � ❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE w PrDESIGN FORM(REQUIRED) MASEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE 7� r- � `• D'2. I n I WAIVER(S)(IF APPLICABLE) 5 x I O DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) 7 ID O r I O ( - SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I IV OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT 0 HOME SALE ['COMPLAINT 0 OTHER: INSPECTOR SOIL LOGS COMMENTS/CONDITIONS ki .2— C5 1'0 4'4 // !VI • -iv v_141.fAic 4) .. �Q Ili 411Vr Ur 7q c, 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. I .• • O*SIGNATURE GATE APPLICATION EXPIRATION DATE COAP: eN APPROVED/ISSUED BY DATE TH • F.;T e•Y BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON)THE MASON COUNTY WEBSITE �� REVISED 12/7/2015 DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 1 0 5 — 5 1 — 0 0 0 1 2 :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" Permit Number: SWG ,-] —CPO 3i5 Designer's Name: Rod Left Applicant's Name: Michael Shoemaker Designer's Phone Number: 360 698 5 Mailing Address: 614 11th Ave SE Designer's Address: PO Box 2954 Olympia WA 98501 Silverdale WA 98383 City State Zip City State Zip Treatment Device 0 Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type: 0 Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: Drainfield Type Qf Gravity 0 Pressure EiTrench 0 Bed ❑Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 5 Schedule/Class 40 Daily Flow:Operating Capacity Li S1) gpd Length 70 ft Daily Flow:Design Flow 600 gpd Diameter 4 in Septic Tank Capacity 1500 gal Number 5 Receiving Soil Type(1-6) 4 Separation 5 ft Receiving Soil Appl.Rate .6 gpd/ft2 Orifices Required Primary Area 1000 ft2 Total Number of Orifices Designed Primary Area 1000 ft2 Diameter in Designed Reserve Area 1000 ft2 Spacing in Trench/Bed Width 3 ft Manifold Trench/Bed Length 335 ft Schedule/Class Elevation Measurements Length ft Original Drainfield Area Slope 5 % Diameter in New Slope,If Altered 5 % Preferred manifold configuration used? 0 Yes 0 No Depth of Excavation Up-slope 12 in Transport Pipe from Original Grade Down slope I ti - in Schedule/Class 40 Designed Vertical Separation 1% _ in Length 100 ft Gravelless Chambers Required? 0 Yes ❑No fiiOptional Diameter 4 in Pump Required? 0 Yes EitiNo Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity gal Orifice ft Chamber Capacity 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 APPROVE 2 0 202 • MASON COUNTY SEP ENVIRONMEN3TAL H . J8w EALrH DESIGN FORM—PAGE TWO Assessor's Parcel Number:3 2 1 0 5 -- 5 1 -- 0 0 0 1 2 Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch liti Test hole locations g Drainfield orientation and layout Reference depth from original grade: 2 Soil logs 21 Trench/bed dimensions and 21 Septic tank 21 Property lines critical distances within layout g Drainfield cover Existing and proposed wells g D-Box/Valve box locations Reference depth from original grade within 100 ft of property 21 Septic tank/pump chamber and restrictive strata: ❑ Measurements to cuts,banks,and locations g Laterals,trench/bed,top and surface water and critical areas 21 Observation port location bottom ❑ Location and orientation of 21 Clean-out location ❑ Curtain drain collector curtain drain and all absorption ❑ Manifold placement 0 Sand augmentation components 0 Orifice placement Other cross-section detail: g Location and dimension of 21 Lateral placement with distance 21 Observation ports/clean-outs primary system and reserve area o edge of bed Buildings Other Information Pi Buildings •i II f Yes No 21 Direction of slope indicator Scale of dra : .I• . e 0 g Design staked out 21 Waterlines MASON COUNT r�;ti vIRONMENTAL y a.« + 0 6�Recorded Notices attached g Roads,easements,driveways, 0 2023 • :-.� ❑Waiver(s)attached parking `� ❑ g Pump curve attached 21 North arrow and scale drawing JBW HEALTH ❑ Evaluation •of failure shown on scale bar Non-residential justification ❑ 21 Waste strength ❑ 21 Flow DESIGN APPROVAL The undersigned designer must be notified by ins 1 • tallation g Yes 0 No _— ai -3t.ti Signa 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 - ite regulations: E nMIlental Health Specialist Date CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: ✓ The design is stamped"Approved"by Mason County Public Health.✓ —�O 4 The Onsite Sewage Permit has not expired,the Permit Expiration Date is: �y ✓ 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 --_��'� lr (\/'/ �4 ( I1 ti p \ ,`L I y1 ____4.4r..._ i i t I I'l I :"1 L"'l-1 I , 1 I ( I 1 i r 1 t/ / II I � �'t 71 ,zr`Irfir .1._____H . 1-- Jl r1 )11 d ----- / - 1,„7t004004, r 2, - ' so NZ \\Ck I __ 1-1..„__, ),.....0 t�\ — 1 , �7 V-------T-- I ill \:\ ty II ;.'-', ,,,, ' \11 ( tr. 6/5/2023, 1:46:50 PM 1.12,258 .ii ) IR ® VI ?: 0.1 00.2 0.4mi County Boundary O SEP 2 0 2023 �, ' 015 0.3 0.6 km D No Filled MAS'�� � . -�NTY ENVIRONh1ENTAl HEALTH r—i Tax Parcels (Zoom in to 1:30,000) JBW SSo s.Esri HERE,Garmin,Intermap.increment P Corp.,GEBCO,USGS, FAO,NPS. NRCAN. GeoBase. ION, Kadaster NL. Ordnance Survey. 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