HomeMy WebLinkAboutSWG2023-00399 - SWG Application / Design - 9/19/2023 cw 584
MASON COUNTY 415N 6THELTON.STREET,SHELT967 .EXT 400
SBELFAIR:360-275-4467.EXT 400
Public Health & Human Services ELMA.360-482-5269,EXT 400
-- FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00399
APPLICANT KLUSMAN KRISTOPHER&TERRI Phone:
Address: P 0 BOX 2816 BELFAIR, WA 98528
OWNER KLUSMAN KRISTOPHER&TERRI Phone:
Address: P 0 BOX 2816 BELFAIR, WA 98528
SEPTIC DESIGNER PAULA JOHNSON -Arrow Septic Phone: 360-898-2255
Designs Inc.
Address: 171 E VUECREST DRIVE UNION, WA 98592
Site Address: XXX NE Alder Creek Ln
Primary Parcel Number: 122052190071
Permit Description: 2-bedroom gravity system
Permit Submitted Date: 09/19/2023
Permit Issued Date: 10/06/2023
Issued By: David Anderson
Current Permit Fees Paid: $525.00 (additional fees may be required upon Installation of system).
Permit Expiration Date: 09127/2026 (based on date ofinspealon)
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.govlhealthlenvironmentallonsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USc ONLY
MASON COUNTY �HWG q cat
COMMUNITY SERVICES a Il g g w
Public Health Cenvnu myHealth Enelorsental H.. h. V Fj Q
SWG 0 �-�- UCS 2
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ON-SITE SEWAGE SYSTEM APPLICATION 3 x
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APPLICANT I.'HOXE r
Kris & Terri Klusman (360) 710-1268 c
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2816
PO Box
MNLINGADDRFB2816TC�-Y.STATE YIp CGOc Belfair, WA 98528 m G SITE ADDRESS ST RESTCTV➢P CCBE NE Alder CreekLn Belfair, WA 98528 1 �
,'• ' �'
".'`y NAME OFDESIGNER Pr-uE IN
Arrow Septic Designs, Inc I (360) 898-2255
NAME OFi NSTAL,YR IFHCNE p IN
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PERTMA A/PE rseAM oner p DR E ,URCE Q
IOCR SIDENTIALOSS 6-COMMUNITY OSS ECOMMERCIAL OSS P INDA.DUAUNELL M. PRI vATE TAOPARTY WE-I- z I al
Q PUEL C WATER SYSTEM
TYPEPE�OFWORKS
pM NEW CONSTRUCTION;UPGRADES ff REPAIR:REPJICEMENT . S ISC RS c "a u.a,: 0 TABLE IX REPA R 1 N
SUEM!TTALS ❑ SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE CO
RE CO
DESIGN FORM RED) —SEPTIC DESIGN IREOUIRED o 1.3 acres a
��warvERrs)oFAPPucnELe) I _ _ 2 BR I x I
o RECTIONE TO ETe AND CONDI.ONS.Ien iocnoe gar.I o
Take Hwy 3 to Belfair. Turn (R) onto NE Alder Creek Ln. Destination on (R).
Yellow sign: "<--Lincoln Lot B/ Klusman Lot A-->" 0 r- I O
Go to the right after you enter driveway. -i
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SIT EMUS?'SE FLAGGED FROM MAIN ROAD A ND TEST MOIFS MUST BE FLAGGED WITH TEST HOLE NUMBERS.
OFFICIAL USE ONLY FROM.HIP LINF--
UPGRADE I FAILURE SOURCE IIC',epofng Pc705es
❑VOLUNTARY 0 MAINTENANCE/PUMPI NG 0 PUILCING PERMIT 0 HOME SALE ❑COVPLP0.T ❑OTHER'.
INSPEC OR SOIL LOGS iF L'EN S CONDII".AS
Tfrii° -S6°' Lm5 U/ 41/
ROW* al 56
TH1 : d-60 Mots
No Mv1c6on f L i 9 'T
eiV
PL OP DR W.I3A> NS'w A-"S:?JOIST
SOIL CODEB'. R-R�.,S CONFE] O I "Lq PRQvA .
V ER G-GRAVEW S SAND Le. E C-C - E
ISPE GNATUR Co
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE
Assessor's Parcel l Number: 1 2 2 0 5 - 2 1 - 9 0 0 7 1_
DESIGNON
n will FORM reviewed when applicable item on checklist
Scaled ILeout sketch including all applicable items on checklist.
A design be 3 go ies of each of the following are submitted)
ated
x Sc plot
design l .ifclu thatglla plicbloiteandn e items on checklist
Webbid_Ado inInn 'one, I1 ' I'„
Scaled This form may bescanned and l available for public view on the Mason CountyWeion sketcW b
du all applicable
PARCEL IDENTIFICATION Arrow Septic Designs Inc
Dcsl ner -Name --
PemttTumber SUG - - (360)
Kris&Terri Klusman Designer s Phone Number 3 1 E 898-2255 Dr
Applicant's Name: _... -
Mailing Address: Be Box 2816 Designer-s:\ddress: -- WA 98592
WA Union,
I ^ yi yAy 9elleir 90520
L� f / City State Zi Cit. State Zip
DESIGN-P:AA.AhIETERS
Treatment Device
❑Glendon Biofiher ❑Sand I'ihut 0 Mound 0 Sand Lined Dmlclkgd ❑ lucirculaung Filter-lypc.
Other
❑ ncrobia Cvii Sta4.0 Model ❑ I)_i rfrofionl n blukcDtodal —
Drainfield Type ❑Cab Surface Drip
fi')Gravity
❑ Pressure 0 Trench Of Bed
Septic Tank/Draiofield Specifications
Laterals
2 Schedule Class 2729
Number of Bedrooms 30 ft .9
Daily Plow:Operating Capacity 180 gpd/ Length
Daily Flow: Design Flow
240 rpd Diameter 4" perf In
Septic Tank Capacity()narking) 1,000 gal-�
Number 3
Receiving Soil Type f I-b) �
3 - Separation 3 R/
Receiving Soil AppL Rate 0.8 gpd!ft` Orifices
Required Primary Area
300 R' of
Total Number of Orifices n/a
Designed Primary Area
300 ft2 Vi Diameter - in
Designed Reserve Area
300 ft' - Spacing - in
Trench/Bed Width 10 ft Manifold
Trench-Bed Length 30 ft Schedule Class 2729
Elevation Measurements
Length 6 ft
Original Drainf 4 Diameter 4 ineld Area Slope '°
New Slope.If Altered 4 ibit Preferred manifold configuration used'_? fio.iYes 0 No
Depth of Excavation Up slope18 in Transport Pipe
from Original Grade Dovm slope 13 in Schedule ( lass 3034 --
Designed Vertical Separation 36+ in Length 30 ft
Graveness Chambers Required? 0 Yes D No fieOptional Diameter 4 in
Pump Required? C Yes reNo Dosing and Pump Chamber
Pump/Siphon Specifications
Limber of doses da} n/a
Duff in Elevation Between Pump& I.ppemiost Or ice -- ----It Dose quantip gal
Drainhield Squirt Height'Selected Residual (head) ft Chamber Capacity Blood) aal
Pump controls: Please check those required.
Capacity! Orifice 0 Highere 0 Lower than Pump Shutoffr LI I irner ❑Elapse Meter ❑ Event Counter
Capacity(u)Total Pressure Head 3Pm
Calculated Fetal Pressure Head
ft If Timer: Pump on Pump oil
Comments r^a ‘ de-.i
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k 6{5 1 CCI u61U%?
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 1 2 2 0 5 — 2 1 — 9 0 0 7 1
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
O Test hole locations g Drainfield orientation and layout Reference depth from original grade:
g Soil logs g Trench/bed dimensions and g Septic tank
611 Property lines critical distances within layout Gi Drainfield cover
gi Existing and proposed wells g D-Bo</Valve box locations Reference depth from original grade
within 100 fi of property g Septic ta]11c pump chamber and restrictive strata:
g Measurements to cuts.banks,and locations Gif Laterals,trenchtbed,top and
surface water and critical areas Observation port location bottom
❑ Location and orientation of g Clean-out location 0 Curtain drain collector
curtain drain and all absorption g Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
66 Location and dimension of g Lateral placement with distance g Observation ports/clean-outs
primary system and reserve area to edge of bed
' g Other Information
EA Buildings R
0 Audibleivisu.. l�rm referenced Yes No
• Direction of slope indicator gScale of dr.
_ •Down on scale d 0 Design staked out
• Waterlines bar 2e .4 ❑ g Recorded Notices attached
g Roads,easements.driveways, �ti. ❑ El.Waiver(s)attached
parking 0'4x ` ❑ ger Pump curve attached
g North arrow and scale drawing V„ NU� ❑ l�Evaluation of failure
shown on scale bar Ca..• 5)00343 '-iFt,d1 Non-residential justification
`- ' PFULA JOY JofMsov'C" % ❑ [yaf waste strength
UCcuSEc ULSIGNEY2..
_"`ccc.-c\-s �� b . ❑ g Flow
DESIGN APPROVAL
The undersigned designer must be ro • led bytinst Iler at time of installation d Yes ❑ No
Signature of Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health and deter}ninedit So be iri
compliance with state and local on-site regulations: —
/�///{�/'//y TO%/a-Z3
Environmental nm Health Specialist Date_ •
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: -
✓ The design is stamped-`Approved' by Mason County Public Health. /( G Jl G(/��
✓ 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.
Lpaated Date: 12_/7/2015
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€RsEMENt 30' O 1,000 Gallon Septic Tank
2-Compartment with Effluent Filter
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Note: (Typical Bed Layout) ,_ -dg}j;/ J
0=Observation Port-to be 4"perforated t L 3^}1."^s..-p_
PVC pipe from bottom of bed to finished n�j 0
grade. A removable cap shall be installed on 6 �� 1
' observation port pipe. Glue"V'on bottom
so pipe can't be removed.
Minimum of 2 in system,one in each corner.
Laterals are to be centered in trenches. P ( ,,t
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SOURCE
APPROVED
MUER
SBTIC TANK
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'•Note: Septic Tanks must meet standards required by WAC chapter 246-272C
and manufacturer must be on the Dept of Health list of registered sewage tanks. "
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Clan o s Septic Designs
INSTALLATION&MAINTENANCE
Gravity Distribution Systems-Bedgy��
4. PAULA JOY IOHNSON
66 LICk'FISEb UESIONEH"
with contour of the ground �� ��� �` �__ '
1. Install Lateralsr�ww:s`o3 -
2, Install bed bottom level.
3. Install locator tape or rebar at each end of all drainfield laterals.
4. Install observation ports as indicated on the dejailed drainfield layout. Minimum of 2
required at diagonal corners of bed drainfield with bottom extending to the
drainrock/native soil interface. Glue"T"to bottom so Observation Port cannot be easily
removed from ground. Install removable cap on top of port at final grade level.
5. Innall drainfield during dry weather and soil conditions; any soil smearing must be
eliminated by band raking.
6. Use distribution box with speed levelers. Divert incoming pipe down with 90-degree
angle to prevent short-circuiting.
7. Filter fabric required ova drain rock prior to back filling. If the drain rock extends above
natural grade,run the filter fabric at least 2 inches down the trench wall.
8. Encase all water lines within 10' of drainfield and under any driveway/parking areas.
9. Divert all storm water runoff away from on-site sewage system.
10.No curtain drains allowed within 10' of the up-slope edge or 30' of the down-slope edge
of the drainfield and reserve area.
11.No vehicular traffic over drainfield area
12.Install Bio-Tube or equivalent effluent filter at outlet end of septic tank
13.All manhole lids and arrsc sampling or inspection ports must have locking covers and,
be located at ground level.
14.Inspect tank and clean filters every 6-12 months as needed.
15.Have the septic tank pumped or professionally inspected every 3 to 5 years.
16.All materials and workmanship must meet County and State regulations.
17.Deviation fiom this design without prior approval from the Designer and Mason County
Environmental-Health Department will make this design null and volt
18.All nauay,rt lines under driveways or parking areas must be encased to prevent crushing.
19.Homeowner is responsible for all property lines.
A Pp
OCT 0 6 202?
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PPGE1OF1PFGES