HomeMy WebLinkAboutSWG2023-00386 - SWG Application / Design - 9/13/2023 M ‘: 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: SWG2023-00386
APPLICANT WHITE SHELLEY Phone:
Address: 19017 4TH AVE NE POULSBO, WA 98370
OWNER WHITE SHELLEY Phone:
Address: 19017 4TH AVE NE POULSBO, WA 98370
SEPTIC DESIGNER CINDY WAITE-Septic Designer Phone: 3607010205
Address: 80 E PICKERING LANE SHELTON, WA 98584
Site Address: 20 N Wynoochee Dr
Primary Parcel Number: 423295000121
Permit Description: 2-bedroom gravity system repair
Permit Submitted Date: 09/13/2023
Permit Issued Date: 09/20/2023
Issued By: David Anderson
Current Permit Fees Paid: $780.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 09/20/2024 (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
MASON COUNTY DATE RECEIVED q • l ' ,
COMMUNITY SERVICES _ — CI) n
AMOI RECEIVE
C c
Public Health(Community Health/Environmental Health) l, 0 m
360-127.9670.eat.400 or 360-275eS467,ext.400
4I5 N.6ih Street•Shelton,WA 90544 S W G 3.0 1,---4 -�o38C1 N
ON-SITE SEWAGE SYSTEM APPLICATION 2
17
APPLICANT
D D
SHELLEY WHITE PHONE m m
360-509-2812 r
MAILING ADDRESS-STREET.CITY,STATE,ZIP CODE Z
C
19017 4TH AVE NE POULSBO WA 98370 m
SITE ADDRESS-STREET,CITY,ZIP CODE
20 N WYNOOCHEE DR
HOODSPORT WA 98548 l'
NAME OF DESIGNER
CINDY WAITE PHONE
360-701-0205 I%
NAME OF INSTALLER
TBD PHONE v It
PERMITRM TYPE(select one) L \�
I RESIDENTIAL O$S 1 I - DRINKING WATER SOURCE I,v
COMMUNITY OSS ifl COMMERCIAL OSS h PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL 0
Z
TYPE OF WORK(select one) Ia PUBLIC WATER SYSTEM LAKE CUSHMAN WS
n NEW CONSTRUCTION/UPGRADES W.REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) '
FPy) ❑ TABLE IX REPAIR I1
SUBMITTALS ❑ SURFACING SEWAGE ®EXISTING FAILURE
DESIGN FORM(REQUIRED) !pI SEPTIC DESIGN(REQUIRED) BEDROOMS El SHORELINE
LOT SIZE W I,
b WAIVER($)(IF APPLICABLE)
2 88'X79' 0
DIRECTIONS TO SITE AND SITE CONDITIONS:(ox.locked gate) I P ,
GO TO HOODSPORT, TURN LEFT ON LAKE CUSHMAN ROAD, TURN LEFT ONTO
WYNOOCHEE DR, FIRST LOT ON THE RIGHT SIDE OF WYNOOCHEE DR. CORNER I,.
OF WYNOOCHEE DR AND LAKE CUSHMAN ROAD. o r
•
IN
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I`
OFFICIAL USE ONLY BELOW THIS LINE---- _ _
UPGRADE/FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOG
\ COMMENTS/CONDITIONS
`nf1 p „761 Ul LS / 30%fireit1
Veer coop oCleel,
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III itty ' SEP 132023IL2)
1ff1: 0 -1 � VG? S
Very /nI,� g
SOIL CODES: -
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E RECORD DRAWING AND INSTALLATION REPORT
-EXTREMELY R-ROOTS REQUIRED FOR FINAL APPROVAL.
INSPECTOR IGNATURE DAZE APPLICATION EXPIRATION DATE
7/7ffL / O/2oz ,APPLICATION APPROVED/ISSUED BY DAM
L______I zoal73_.
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE /
y>r: iZ REVISED 12 7r2o±5
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DESIGN FORM-PAGE ONE Assessor's Parcel Number: V_231 _ __
A design will be reviewed when 3 copies of each of the following are submitted: _� O I Z
l'Completed design form that has been signed and dated. v
Scaled n checklist
`i Scaled plot plan,including all applicable items on checklist. Cross-sectic n sketch,including all applicable items cluding all applicable items on checklist.
This form may be scanned and available for public view on the Mason County Web site.Maximum paper size: /1"X 17"
PARCEL IDENTIFICATION j
Permit Number: SWG �ZJ-a03g6 1
Designer's Name: CINDY WAITE
Applicant's Name: SHELLEY WHITE
Designer's Phone Number: 360-701-0205
Mailing Address: 19017 4TH AVE NE 80 E NORTH ISLAND DR
Designer's Address:
POULSBO WA 98380
SHELTON WA 98584
City State Zip
City State Zip
DESIGN PARAMETERS
Treatment Device
❑Glendon Biofilter ❑Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model
Other:
Lo(GravitDrainfield Type
Y 0 Pressure ❑Trench ❑Bed
0 Sub Surface Drip
Septic Tank/Drainfreld Specification-
Number of Bedrooms Laterals
2 Schedule/Class ASTM 2729 Daily Flow:Operating Capacity 180 d gp - Length 30
Daily Flow: Design Flow 240 Diameterfti/
gp .
Septic Tank Capacity(working) 1000 EXISTING ' 4 irr`
gal Number 3 .."-
Receiving Soil Type(1-6) 3
Separation 3 ft -- ----
Receiving Soil Appl. Rate .8 gpd/f
Required Primary Area 300 2 �/ Orifices
ft Total Number of Orifices ASTM 2729 PERF
Designed Primary Area 300
ft- `7 Diameter
Designed Reserve Area 300+ 2/ in
ft Spacing
Trench/Bed Width 10 in
ft Manifold
Trench/Bed Length 30 ft " Schedule/C, s
•
Elevation Measurements Length 0,Or �11
1
Original Drainfield Area Slope <1 o i 01 !Z
/o Diam ,v
New Slope, If Altered % ��' !, •
in
Prc � , ok�it+; ` 1.•n' ,uration us" ? ❑ Yes 0 No
Depth of Excavation Up-slope 24 ``0 "�h
from Original Grade to N •_ ", i• /IIt Tj�i�if1' Pipe
Down-slope 22 ff,,``
in a:41 dule s `� f 3034
Designed Vertical Separation 24 "" y a'• 8 % t
in j Genf: DY WAITE lb ft
Gravelless Chambers Required? 0 Yes !d No 0 O tio! '.LICENSES)DESIGNER 3,
`
.44„
Pump Required? 0 Yes 0 No EXPIRES 05Oi
Pump/Siphon Specifications Dosing and Pump Chamber
UppermostNumber of doses/day
Diff. in Elevation Between Pump& Orifice ft Dose quantity
Drainfield Squirt Ileight/Selected Residual(head) gal
ft Chamber Capacity(flood) gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls: Please check those required.
Capacity(a),Total Pressure Head
gpm ❑Timer ❑Elapse Meter 0 Event Counter
Calculated Total Pressure Head ft If Timer: Pump on Pumpoff
Comments
EXISTING SEPTIC TANK TO BE RETROFITTED WITH RISERS AND EFFLUENT FILTERr'' \ .
1.
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DESIGN FORM—PAGE TWO Assessor's Parcel Number: 171 o?,7 Z
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch
�TCst hole locations Cross-Section Sketch
�✓Drainfield orientation and layout Reference depth from original grade:
fa' Soil logs IIY Trench/bed dimensions and
l 'Property lines critical distances within layout ❑ Septic tank over f, ,�
l7' Existing and proposed wells !B/D-Box/Valve box locations �Drainficld cover
within 100 ft of property Reference depth from original grade
�,,,��nn�� 0/Septic tank/pump chamber
►'v0"'Measurements to cuts, banks,and locations t°j vi- ,,r,� and restrictive strata:
surface water and critical areas Laterals,trench/bed,top and
Observation port location
OIL-Location and orientation of 0 Clean-out locationbottom
curtain drain and all absorption placement 0 Sand augmentation �„!,�
0 Curtain drain collcctor�j�
❑
components Manifold
Location and dimension of 0 Orifice placement Othe�r,c�r ss-section detail:
Lateral placement with distance 6�'" Observation ports/clean-outs
primary system and reserve area
Pf Buildings to edge of bed
6d(Direction of slope indicator
Other� udiblc/visual alarm referenced Yes No Information
Ll�Waterlines ID/Scale of drawing shown on scale fib 0 Design staked out
bar 0 0 Recorded Notices attached
Roads,easements,driveways,
/parking 0 0 Waiver(s)attached
02 North arrow and scale drawing 0 ❑ Pump curve attached
shown on scale bar — PI 0 Evaluation of failure
Aft' 6 Non-residential justification
/,n,� 0 0 Waste strength
0 ❑ Flow
DESIGN APPROVAL
The undersigned designer must be noti by inst cr at time of installation ..Yes 0 No
Signatur Designer
PPROVED
The undersigned has reviewed this design on behalf of Mason County Public Health and determi
compliance with state and local o . regulations: ned it to be in
�i z SEP 2 0 2023
O 7V �/ MASON COUNTY ENVIRONMENTAL HEALTH
i nmental ealth Specialist Date 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: g ZO
✓ Drainficld site conditions have not been altered to adversely affect conditions of design approval..
Please Note: The system must be installed by a certified install
unless prior authorization is obtained from Mason CountyPublic Health.
An Installation Fee is required.
This form may be scanned and available for public view on the Mason County Web site. I
Updated Date: 1 2,(7,G/0 15
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Installation Notes
Gravity Distribution System:
20 N Wynoochee Dr. 42329-50-00121
1. Original system was installed in 1987. 40' of deeptrench. Trench was A I with roots
and a shop was built over it. f�
2. Gravel based drainfield required. ^1 P&
3. Retro fit existing septic tank with risers and effluent filter ® S `
4. Designer and installer to meet on site prior to installation
5. Install system during dry weather with acceptable soil conditions�AS�NCOU SEP? 2023
6. Keep wheeled vehicles off the drainfield area before, during and after installa ',A .NME
Tracked equipment only, h
7. All ground, surface water and roof drains must be diverted away from the sI�(kir�
and drainfield. Ensure the final grade slopes away from these areas and waters doesn't
collect on or around them. Use swales, berms, catch basin and tight lines, curtain drains,
etc. to divert all waters.
8. Curtain drains can be no closer than 10' upgradient and 30' down gradient of the
drainfield
9. Exposed restrictive layers, cuts, banks, etc. can be no closer than 50' downhill from the
drainfield.
10. Install access risers on the septic tank, D-box and observation ports.
11. Make sure septic tank risers are epoxied or caulked to cast in riser rings on tank.
12. Lids must form a water and gas tight seal with the access risers
13. Install effluent filter at the septic tank outlet.
14. This system must be installed by a Mason County Certified Installer.
15. Deviation from this design without prior approval from the designer and Mason Count
Health Department will make this design null and void. y
16. This design was sized per Washington Administrative CodeWAC246-272A-0230. The
operating capacity is based on 45 gallons per day
r ns per
bedroom. The minimum design flow per bedroom perdaypis the operatwith twoing capacityers of
ninety gallons multiplied by 1.33. This results in a minimum design flow of one hundred
twenty gallons per day. This creates a surge factor of 33% but anticipated flow is ninety
gallons per bedroom per day.
17. Install laterals or bed with contour of the ground
18. Install trench bottoms level and always maintain a minimum of six inches into native soil
19. Filter fabric required over drain rock prior to backfilling. If the drain rock extends above
the original grade, run the filter fabric at least 2 inches down the trench wall.
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System Owner Responsibilities:
1. Operation and Maintenance is required by Washington State Department of Health and
Mason County Health Department.
2. The septic tank should be pumped every three to five years or as needed.
3. System owners are responsible for having maintenance performed every three years as
per WAC246-272A.
4. System owners are responsible for responding to septic issues in a timely manner.
5. System owner agrees to read and abide by information regarding their system in the
User Manual provided by Mason County Public Health.
6. Keep the flow of sewage at or below the approved design operating capacity.
7. Keep waste strength at residential waste strength parameters.
8. Spread loads of laundry through the week.
9. Do not use excessive bleach or detergents with added whiteners.
10. Do not shower, do laundry and dishwasher at the same time
11. Antibiotics can kill or impair the biological process in the septic tank.
12. Leaky plumbing can hydraulic overload your on-site septic system.
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