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HomeMy WebLinkAboutSWG2023-00407 - SWG Application / Design - 9/22/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 BELFAIR:360-275-4467,EXT 400 at, ELMA:360-482-5269,EXT 400 Public Health & Human Services FAX:360427-7787 On-Site Sewage System Permit: SWG2023-00407 APPLICANT HOUSE JONATHAN &JAMI Phone: 360-490-1250 Address: 367 SW 6TH ST CHEHALIS, WA 98532 OWNER HOUSE JONATHAN &JAMI Phone: 360-490-1250 Address: 367 SW 6TH ST CHEHALIS, WA 98532 SEPTIC DESIGNER CHRIS ELSTROTT-Advanced Phone: 360-561-5000 Engineering Address: 128 NORTH RIVER STREET MONTESANO, WA 98563 Site Address: W Bulb Farm Rd Primary Parcel Number: 519144190020 Permit Description: New SFR -3BR Gravity Permit Submitted Date: 09/22/2023 Permit Issued Date: 09/28/2023 Issued By: Jeff Wilmoth Current Permit Fees Paid: $780.00 (additional fees may be required upon installation of system). Permit Expiration Date: 09/28/2026 (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. DATE RECEIVED. MASON COUNTY _..2 --- C D • AMou p RECEIVED BY, /� ^ m '�'-►. COMMUNITY SERVICES �� Public Health(Community Health/Environmental Health) ^/�\ 'I}� wo 415N 60,70,Sreert Sh arn,WA M67.e.[.400 SWG / Y - V - o31-kO' l o ~ 415 N 6th Street-N�elrmt WA 985A4 z di 13 ON-SITE SEWAGE SYSTEM APPLICATION m x APPLICANT PHONE mr l /-7‘vse-- 340 - 5170 - 12SZ Nku, Z MAILING A11,/SS-STREET,CITY,STATE,ZIP CODE 0 3d 7 (S-w e(fA sf', C 9f5-3z- k m SITE ADDRESS-STREET,CITY,ZIP CODE Q ti Bv« �,41/e.h fr�.4,0 , swe�ra ti, ‘A,"V f P� & y - ., 1 NAME OF DESIGNER PHONE I` Chile/f gefrn&it 3r:o - S-1 / - 5-71)00 I W NAME OF INSTALLER PHONE 0 �0-' sr- yis4 < I� �vf� 1Ti•K, cn PERMIT TYPE(select one) DRINKING ATER SOURCE rieffSIDENTIAL OSS fl COMMUNITY OSS P COMMERCIAL OSS r PRIVATE INDIVIDUAL WELL C7 PRIVATE TWO-PARTY WELL Z I PUBLIC WATER SYSTEM TYPE OF WO (select one) — 1 I 1 W CONSTRUCTION/UPGRADES Cl REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR ❑ SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINE I SUBMITTAL r l'iiESIGN FORM(REQUIRED) PTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE O WAIVER(S)(IF APPLICABLE) 6• 6 ? 0 ' DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) * I o h /-cf /1, /21PL1 94, •s . 1 0 6-O ' A/f �/ GDC '�v '� �n/£i/%(4 L /.0 2/z f , r, I I �jti (e /$ /h J�l�e� b d�C . I SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGE TH TEST HOLE NUMBERS. UPGRADE!FAILURE SOURCE(tor reporting purposes) ❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE ❑COMPLAINT 0 OTHER: COMMENTS/CONDITIONS INSPECTOR SOIL LOGS *01\ ( e1.7) (`IL )4) or 9,bs It/ t \ -V- t)‹t__, _. .,,,i N 0--''° LS 0 C,.0 .4itrp RECORD DRAWING AND INSTALLATION REPORT SOIL CODES: UIRED FOR FINAL APPROVAL V= ERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS APPL ATIVLA �IISS DATE INSP TOR SIGNATURE DATE APPLICATION EXPIRATION DATE If • AANMi q )-1) THI F AY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 1217/2015 DESIGN FORM—PAGE ONE Assessor's Parcel Number: f L 9 / `Z -- _E / -- 7g o 0 2 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 2023 Designer's Name: G•O•eis .EG c 7Jpi1T" �C7 Desi Applicant's Name: #b/ /vsS Designer's Phone Number: .26D — SS i —Stbo Mailing Address: 34 7 fw 6A S Designer's Address: /2-6 it,', .P,,' s-7- G 1/47-,4us 4,4 ,2of3L "ply or S440 aturf 9.64-6.7 State Zip City State •Zip Cl n�7 �{�� �i a r x1 c�ro ;tom` 3-.�iaC+z'g,��.+ �tc`,�,Yv �' ,��c'i�fc�+tom.. a� _ ^V p a 1 -;",Yr {.... V S11GN AR METER r .�Re.,C.�+�i ;"Ll..ra.� - ,,4 :.> ..., ..; " .',��'�,'.M-...y�'^�-.u�.•.��Jcyc My��,'�� a� 4.s"�=��c..t,_r,:2`ti.V.>+..t�-^-M'� .' Treatment Device ❑ Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type: ❑ Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: 6.-.0."orvi 3 Drainfield Type El Sub Surface Drip avity 0 Pressure 0 Trench ed Septic Tank/Drainfield Specifications La rals Number of Bedrooms 3 Schedule/Class ft Daily Flow:Design Flow Daily Flow: Operating Capacity LengthJig, gpd �� r-. .3 Iv gpd Diametercit X Gj in Septic Tank Capacity /z oc gal Number ,,rJ,6� Receiving Soil Type(1-6) 3 Separation � ft Receiving Soil Appl.Rate B gpd/ft2 Orifi es Required Primary Area 9S-ro ft2 Total Number of Orifices Designed Primary Area 5/co ft2 Diameter in Designed Reserve Area V7-0 ft2 Spacing in TrenchBed Width 9 ft Manifold Trench! e_g_th ro ft Schedule/Class /3s 77,1 3o 3e/ cr ft Elevation Measurements Lengthy Original Drainfield Area Slope p % Diameter in New Slope,If Altered o % Preferred manifold configuration used? 0 Yes 0 No Depth of Excavation Up-slope Zy in Transport Pipe from Original Grade Down-slope 2y in Schedule/Class Asrm 3. 37, Length 2 5— ft Designed Vertical Separation --6 in Len g Gravelless Chambers Required? CTYes 0 No 0 Optional Diameter in Pump Required? 0 Yes ❑` Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day gal Difference in Elevation Between Pump Shut and Uppermost Dose quantity gal Orifice Chamber Capacity Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check Pr ❑'.those required. ❑Event Couater - Capacity @Total Pressure Head /l��/9 gPm ❑Time s a a. Calculated Total Pressure Head /I/// ft If Timer: Pump on � Wriv ''- S ' Comments EP 2 8 2023 MASON COUNTY ENVIRONMENTAL HEALTH JBW imaimummuw • DESIGN FORM—PAGE TWO Assessor's Parcel Number: r/2 -- 9" -- Ze:2 D Z o Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch est hole locations 13-15ainfield orientation and layout Reference depth from original grade: oil ogs rench/bed imensions and 0 Septic tank C�Property lines critical distances within layout 0 Drainfield cover • xisting and proposed wells x/Va1ve box locations Reference depth from original grade within 100 ft of property Septic tank/pump chamber and restrictive strata: A Measurements to cuts,banks,and locations 0 Laterals,trench/bed,top and su water and critical areas 9 ' bservation port location bottom ocation and orientation of Mean-out location 0 Curtain drain collector curtain drain and all absorption Er—Manifold placement 0 Sand augmentation components LE-Orifice placement Other cross-section detail: cation and dimension ofral placement with distance 0 Observation ports/clean-outs p .m.ary system and reserve area to edge of bed Other Information DAluil 'ngs . Audible/visual alarm referenced Yes No CVDirection of slope indicator 17 le of drawing shown on scale 0 0 Design staked out aterlines bar 0 0 Recorded Notices attached oads, easements, driveways, 0 0 Waiver(s)attached , parking 0 0 Pump curve attached l3 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 notif by installer at time of installation es ;-- �D 1� � eroe of esigner Date 'Safi 00� `SFA 84/7i,„ c frAk The undersigned has reviewed t '1/ 1 4 esignon behalf of Mason CountyPublic Health and dete gn ��� 8,b .�'. compliance with state and locai to re t lotions: �� �F�� E, : ealth Specia ist Date ,/4 CAUTION: DESIGN APP•. I VAL 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: `"/ 2.2_- ✓ 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. 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