HomeMy WebLinkAboutSWG2023-00442 - SWG Application / Design - 10/18/2023 584
MASON COUNTY 415N6THELTON: ,SHELT967 , EXT 400
SH STREET,
360-02T-9674 EXT 400
BE 360-482-526 EXT400
Public Health & Human Services ELMA::3609, X
FAX:S36D-427-7787
On-Site Sewage System Permit: SWG2023-00442
APPLICANT STALEY ET AL, COLE MICHELE Phone:
HOLMES
Address: 231 NE Waterhill Rd TAHUYA, WA 98588
OWNER STALEY ET AL, COLE MICHELE Phone:
HOLMES
Address: 231 NE Waterhill Rd TAHUYA, WA 98588
SEPTIC DESIGNER ROD LEFT-Acme Design Phone: 360-698-8488
Address: PO Box 2954 SILVERDALE, WA 98383
Site Address: 231 NE Waterhill Rd
Primary Parcel Number: 222064290080
Permit Description: 4-bedroom pressure system
Permit Submitted Date: 10/18/2023
Permit Issued Date: 10/30/2023
Issued By: David Anderson
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 10/26/2026 {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/environmentallonsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
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a - OFFICIAL USE ONLY
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MASON COUNTY ` � OD M
Public Health(Community nmental Nea,mi to w O
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ON-SITE SEWAGE SYSTEM APPLICATION 3 23
APPLICANT I PRONE m m
r
Michele Holmes & Cole Staley,
3
MAILING ADDRESS-STREET,CMS SEATS,ZIPCODE co231 NE Waterhill Rd Tahuya WA 98588 z
SITE ADDRESS-STREET.CITY,ZIP'.ODE
231 NE Waterhill Rd Tahuya WA 98588 I N
NAME OF DESIGNERS I N
Rod Left ' 360-698-8488
NAME DF INSTALLER 'I`
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N to
PERMIT
TYPE"Deep One) I DRINKING-WATER SOURCE 5
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VRESIDENTIAL 55$ C 11COMMUNIY OBS [COMMERCIALOSS 5 PRIVATE INDIVIDUAL WEL aPRIVATE TWO-PARTY WELL Z ICD
Pi.PUBLIC WATER SYSTEM Tanya RM1er Valley Water OS*1 ST 15
TYPE On WORN Fee.ra,m I a
V'NEW CONSTRUCTION i UPGRADES E REPAIR I REPLACEMENTOTHER DETAILS( M ec,am at aDPIA ❑ TABLE IS REPAIR
0 SURFACING SEWAGE ❑EXISTING FAILURE 0 SHORELINE
n ..YY SUBMrrALS L - m I N
','�� 1F.DESIGN FORM(REQUIRED) FSEPTIC DESIGN(REQUIRED) BEDROOMS 4 LOT SIZE QQ
p 110,206
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UPGRADE.FAILURE SOURCE(for Iexniy purposes)
❑VOLUNTARY 0 MAINTENANCGPUMPING 0 BUILDING PERMIT ❑HOME SALE ❑COMP'LAINT ❑OTHER.
NAPE ORSOIILLC C COMMENTS DNOIIIONS 4
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tl i I 9ECORD DRAWING AND INSTALLATION REPORT
S=VERYL GRAVELLY s=SAND L CODES.
G =LOAM S.,SILT C=CLAY ==EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
iNS,F.CTDR SIG DATE I APPLICATION EXPIPATFON CPT' AFPL GA�pp _ ISSUED BY
DATE
aeft 008 /0/2a/70?6 - 7O7Jo7zoz3
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE
a EYIDED 12712m5
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 2 0 6 — 4 2 — 9 0 0 8 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 an applicable items on checklist
Scaled plot plan,including all applicable items on checklist. S 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: I"X I7"
PARCEL IDENTIFICATION.'
3 4/ Rod Leg
Permit Number: SWG 2a �GQ -1 �� Designer's Name:
Mionele Holmes&Cole Staley Designer's Phone Number: 360-698-8488
Applicant's Name _ —
231 NE Waterhill Rd Designer's.Address: PO Box 2954
Mailing.Address: _
Iahuya WA 98588 Silvercale WA 98383
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device
❑ Glendon Biofilter ❑ Sand Filter ❑ Mound 0 Sand Lined Grainfield 0 Recirculating Filter Type.
❑Aerobic Unit Make/Model _ ❑ Disinfection Unit Make/Model( Other_
� Drainfield Type
❑Gravity b]Pressure gTrench ❑Bed ❑ Sub Surface Dnp
Septic Tank/Drainfield Specifications laterals
Number of Bedrooms 4 — Schedule/Class 40 e
Daily Flow.Operating Capacity 3feo gpd Length 50 ft ,
Daily Flow.Design Flow 480 gild' Diameter 1 in
Septic Tank Capacity
1250 gal ' Number 4
Receiving Soil Type(1-6) 0.8 Z Separation 5 ft
Receiving Soil Appl.Rate .8 gpdc Orifices
Required Primary Area 600 ft2 Total Number of Orifices 50
Designed Primary Area 600 ft',
Diameter 1/8 in
Designed Reserve Area 600 ft2 Spacing 48 in
Trench/Bed Width 3 ft -llManifold
Trench,Bed Length
200 ft / Schedule/Class 40
Elevation Measurements Length 40 ft
Original Drainfi cid Area Slope 10-15 ro Diameter 1 in
New Slope,If Altered 10-15 % Preferred manifold configuration used? DYes D No
Depth of Excavation Up slope 12 Transport Pipe
from Original Grade 1Jawo-slopc 8 in Schedule/Class 40
Designed Vertical Separation 24 in I Length 135 ft
Gravelless Chambers Required', ❑Yes 0 No al Optional Diameter 2 in
Pump Required? g Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 8
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity 59.47 cal
�Z
Orifice .12II— Chamber Capacity Ztn� aU OR gal
Uppermost Orifice g Higher 0 Lower than Pump Shutoff Pump c�o/ntrols. Please check those required.
n'1Timer Elapse Meter g Event Counter
Calculated Totalt PressurePessu Headadd 3.1 ft Pump P 3 Pump 3hrs
Calculated 33.'f - h If Timer: on�. �n �5�. , off
Comments.�—s"R\54'l J cfm,„71,4,,_ kt, IDC PotAzve , C. / ,
.�tnr,p Ies•AZ 1. 4-u>0 erseaS _ OCT ; 02Ot3
t,r-��,AL HEALTH
i.14
DESIGN FORM—PAGETWO Assessor's Parcel Number: 2 2 2 0_ 6 — 4 2 — 9 0 0 8 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
1 Test hole locations Pi Drainfield orientation and layout Reference depth from original grade:
O Soil logs g Trench/bed dimensions and 1 Septic tank
921. Property lines critical distances within layout 21 Grainfield cover
O Existing and proposed wells g D-Box/Valve box locations Reference depth from original grade
within 100 ft of property iii Septic tank/pump chamber and restrictive strata:
21 Measurements to cuts,banks, and locations g Laterals,trench/bed,top and
surface water and critical areas cIf Observation port location bottom
❑ Location and orientation of 0 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption g Manifold placement ❑ Sand augmentation
components 21 Orifice placement Other cross-section detail:
• Location and dimension of Lateral placement with distance g Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
IZI Buildings 0 Audible/visual alarm referenced Yes No
EZI Direction of slope indicator 1 Scale of drawing shown on scale ❑ E0 Design staked out
O Waterlines bar ❑ g Recorded Notices attached
g Roads, easements,driveways, ❑ g Waiver(s)attached
parking Gti ❑Pump curve attached
O North arrow and scale drawing ❑ 2i Evaluation of failure
shown on scale bar Non-residential justification
❑ RI Waste strength
❑ gFlow
DESIGN APPROVAL
The undersigned designer must be notified by",at time o£urstallation PJ Yes ❑ No
6 ocIsrr zz
ature of Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it tu3#ux i- c ,
compliance with state and local on-sit lations: a i 1 R
yyq -.
(0/ / OCT80 °� -
Environmental Health Specialist ate (/))f
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION //yd
si The designis stamped"Approved"byMason CountyPublic Health.
PP lO(z6/307c /`l(
/ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
it 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
Pump Selection fora Pressurized System -Single Family Residence Project
H OLM E S/72906-42-90080
Parameters 160
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