HomeMy WebLinkAboutSWG2023-00385 - SWG Application / Design - 9/13/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
effla •s
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: SWG2023-00385
APPLICANT Bo Russell Phone:
Address: PO Box 336 MONTESANO, WA 98563
OWNER SCHAEFER MICHAEL PRESTON JR & Phone: 360-292-2985
TANYA HATFIELD
Address: 760 E THORNTON RD SHELTON, WA 98584
SEPTIC DESIGNER CHRIS ELSTROTT-Advanced Phone: 360-561-5000
Engineering
Address: 128 NORTH RIVER STREET MONTESANO, WA 98563
SEPTIC INSTALLER BO RUSSELL-septic installer Phone: 360.589.7957
Address: PO Box 336 MONTESANO, WA 98563
Site Address: 746 E Thornton Rd
Primary Parcel Number: 221357590144
Permit Description: 4-bedroom pressure system
Permit Submitted Date: 09/13/2023
Permit Issued Date: 09/25/2023
Issued By: David Anderson
Current Permit Fees Paid: $780.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 09/22/2026 (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 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.
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.
UAit R(CFIVFD. A 1 3
- MASON COUNTY M` C cn
AMOUNjLQ � CO m
COMMUNITY SERVICES14.rialtii L7�Yv`J] • G
En
' Pubbc Health(Community Health/Emnronmcntal Health} SWG 1 _ 0038'-
ON-SITE41N584S V VG i-'JtlN51N SEWAGE SYSTEM APPLICATIONm
PHONE r
APPLICANT 3(J —/a - s- G)' 79 f� Z
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MAILING ADDRESS-STREET.CITY.STATE,ZIP CODE
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7°0 i3ox 7/ 6 . /120� nr.3-4�n c�,o !�fS� i WFR
SITE ADDRESS-STREET.CRY,ZIP CODE - N I IV
7Y6 E• T10/ea1ti /z0 -1 S.5/aeTa'� '9 fire' °' I
NAME OF DESIGNER PHONE (Ni
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PHONE '0
NAME OF INSTALLER 0 I♦�
assZ� G° - re - .- f Z
�� DRINKING WATER SOURCE O
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PERMIT TYPEone) r ,NIVATE INDIVIDUAL WELL PRIVATE TWO-PARTY WELL Z I
uENTIENTIAL OSS rl COMMUNITY OSS r1 COMMERCIAL OSS
3 PUBLIC WATER SYSTEM
TYPE OF WORK(select one) I�)
CONSTRUCTION/UPGRADES rl REPAIR!REPLACEMENT OTHER SURFACINGDETAILs(select all Mal SEWAGE0 E 0 nABLAILURE 0 SHORELINE W �N
r
SUBMITTALS LOT�7F O
SIGN FORM(REQUIRED) PTI EC DESIGN(REQUIRED) BEDROOMS /•/ �`• 0n WAIVER(S)(IF APPLICABLE)
V - X I\'o
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex Iod`ed gate) Ty ��� Q Q�J/G I
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or ru,4-O Go1/✓‘ Sorn ° ✓ ,2/4gr. 7- --1
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SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS.
UPGRADE I FAILURE SOURCE(tor reporting purpoSes)
0 VOLUNTARY 0 MAINTENANCEPUMPING 0 BUILDING PERMIT ❑HOME SALE ['COMPLAINT COMMENTS
INSPECTOR LOGS CONDITIONS
SOIL
O - WO , IVE o d 1
(. SEP 13 2023
Go c 5��► By.
ikG : 0 - 60 vein/15 Lino Kt
RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES: REQUIRED FOR FINAL APPROVAL.
V VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS DATE
Appl- APPROVED/Iccl iED BY
INSPECTOR SIGNATURE /G 7 7r/DATE APPLICA7/z2z0$TKNNEXPIRATION
DATE
7/Z5/ 6
(/ZZ/ 073 . - 17/7/2015
42 -- REVISED
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE
ft
• DESIGN FORM-PAGE ONE Assessor's Parcel Number: 2 Z / 3 r -- 7 r -- L D / -Ky
A design will be reviewed when 3 copies of each of the following are submitted:layoutdetch,including all applicable items on checklist
�Compicted design form that has been signed and dated.
Scaled plot plan,including all applicable rtems on forkecklist. ."Cross-section public view on the Mason Countyh,including all applicable Web site.Maximum paper sizes o11"checklist."
This form may be scanned and available _ _
PARCEL IDENTIFICATION. .; :"
Permit Number: SWG Z0 Z3 -0 O/8 Designer's Name:
LAWS Are$771246/7"
Applicant's Name: r,,5� SU
G- Designer's Phone Number: 34, - r6/- ra o 0
- �Z�li�'/L ST
f20/JC X 33 6 Designer's Address: /20 N
Mailing Address: �y��p w� �B�3
/y/�MES��wr4 g6/S�3 Cr / State Zr
Cr State Z ((•� ti .. .s�� a .. . .�,s � �.�,
i x s Z
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield ❑Recirculating Filter,Type:
❑Aerobic Unit Make/Model
0 Disinfection Unit Make/Model Other: /P/tess• %2•
D infield Type ❑ Sub Surface Drip
❑ Gravity r•essure
p"I wench 0 Bed
Septic Tank/Drainfield Specifications j
Laterals
Number of Bedrooms 1/ ✓ Schedule/Class 200 �"
3 N d Length 5'�. sr. CS-i 3f
ft
Daily Flow:Operating Capacity ✓ 60 �%y in
Daily Flow:Design Flow
�g0 gpd / Diameter
ogal � Number
Septic Tank Capacity(working) /?� 5/
7, Separation
8
/d ft 7.--
Receiving Soil Type(1-6) � Orifices
Receiving Soil Appl.Rate D gp�
Required Primary Area
ft2 Total Number of Orifices y�
ft2 Diameter inDesigned Primary Area ��4 /Designed Reserve Area 100 ft2 Spacing � in/ Manifold
Trench/Bed Width 3 ft
ft Sc e/Class YI9
1 Trench/Bed Length _ ft
Elevation Measurements Length .2- in
Original Drainfield Area Slope
�/0 % =- Diameter
% Preferred manifold configuration used? es 0 No
New Slope,If Altered ` � Transport Pipe
Depth of Excavation Up-slope 2y " in ' 4/0from Original Grade -slope 22— in ,' Scaed a/Class
. _/ Length /� ft
Designed Vertical Separation 2 2- in
Gravelless Chambers Required? es ❑No 0 Optional Diameter
es ❑No Dosing and Pump Chamber
Pump Required? ,3
Pump/Siphon Specifications •Number of doses/day
Uppermost Orifice /0 ft Dose quantity /G gal .
7
Diff.in Elevation Between Pump& o gal
Chamber Capacity(flood) /ZGa
Drainfield Squirt Height/S lected Residual(head) —ft Pump contro :Please check thos required.
Uppermost Orifice igher 0 Lower than Pump Shutoff Capacity @ Total Pressure Headimer apse Meter vent Coutiter
38 gpm
ft If Timer: Pump on Td SYA ,Pump off
Cal 1i111(► 1 i47-ljvstiau/4n
041
Comments
SEP 2 5 2023
:.'JA
,
) DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 z / ss S' -- 7 f -- 2 l 5/3
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scale Layout Sketch Cross-Section Sketch
est ole locations Dr ' field orientation and layout Reference depth from original grade:
oil logs CYTr�1 ±/bed dimensions and ❑'Stic tank
roperty lines cri ical distances within layout ❑ rainfield cover
xisting and proposed wells Nalve box locations Reference depth from original grade
within 100 ft of property eptic tank/pump chamber and restricts strata:
Measurements to cuts,banks, and locations
0—laterals,trench/bed,top and
surface water and critical areas bservation port location bottom
ocation and orientation of �le '-out location alq Curtain drain collector
cugairrdairt-arid all absorption Dc 4 ifold placement g Sand augmentation
co ponents ❑ tf p e placement Other cross-section detail:
ocation and dimension of ateral placement with distance 0 Observation ports/clean-outs
prjpiary system and reserve area toe a of bed Other Information
D'Bui ings 0 udi le/visual alarm referenced Yes No
0-41ityction of slope indicator 0 ale of drawing shown on scale 0 12115 gn staked out
at lines bar 0 orded Notices attached
oads, easements,driveways, ❑ aiver(s)attached
park.ng ❑ 11;mr curve attached
orth arrow and scale drawing
❑ valuation of failure
shown on scale bar Non-res''ential justification
m P aste strength
is = - •w
DESIGN APPROVAL
The undersigned designer must be notified by installer at time of installation 04s ❑ No
y`r--3
Signature of Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health and deteand C)VE D
compliance with state and local on-s. regulations:
r/71/?eZ3 SEP 2 5 2023
Environmental Health Specialist Date ':'ASO,A COUNTY ENVIRONMENTAL HEALTH
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITIO1WA
✓ The design is stamped"Approved"by Mason County Public Health. 7/'21 '72'Oz
✓ 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
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