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Home My WebLink AboutSWG2023-00452 - SWG Application / Design - 10/23/2023 MASON COUNTY 415 N fiTH STREET,SHELON,VVA 98564 SHSE: 7-967 ,EXT 400 BELFAIR:360-275-4467.EXT 400 . Public Health & Human Services ELMA:360-482-5269,EXT 400 FM:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2023-00452 OWNER LEA NATHANAEL E&MICHELLE L Phone: Address: 12055 BANNER RD SE OLALLA, WA 98359 APPLICANT LEA NATHANAEL E & MICHELLE L Phone: Address: 12055 BANNER RD SE OLALLA, WA 98359 SEWAGE DESIGNER Lawrence Purdum-Apex Septic Design Phone: 253-509-9922 Address: PO Box 801 GIG HARBOR, WA 98335 SEPTIC INSTALLER JOSH PETERSON-Kattrax Inc Phone: 253-255-6799 Address: 14198 COLONY AVE SOUTHEAST PORT ORCHARD, WA 98367 Site Address: 3870 E Mason Lake Dr W Primary Parcel Number. 221055100020 Permit Description: Replace septic tank with NuwaterBNR500 Permit Submitted Date: 10/23/2023 Permit Issued Date: 10/30/2023 Issued By: Rhonda Thompson Current Permit Fees Paid: $255.00 (additional fees may be required upon installation of system). Permit Expiration Date: 10/23/2024 (based on date of nspemmn) Type of Work OSS Repair Components being Replaced: Septic Tank Only Surfacing Sewage? No Existing Failure? Yes Shoreline? Yes Horizontal Setbacks Met? Yes Number of Bedrooms: 2 Drinking Water Source: Private Well/Spring Additional Details: Nuwater BNR500 Permit Conditions: 4 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 3 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. 1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 2 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF 055. 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/OR 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 USE ONLY --- MASON COUNTY PUBLIC HEALTH DATLR CErW Lb -93 -a3 ONSITE SEWAGE SYSTEM APPLICATION AMOUNT RECEIVED. RECENFD o N 415N 6th SBeet,(Bldg8) Shelton WA,98584 CAFE) 0• m Shelton:360427-9670eXt400 BeRair:360-275-4467 at 400 SWG ca A6 - ^o' Ica y O q((J O �I. • A Z en Z D APPLICANT PHONE D A Nathaniel Lea 360-710- r m m HAWING ADDRESS STREETCIrvi STA E.ZIP CODE �LJ� V LJ ', $ r 12055 Banner Rd SE ? c GET172 t_ m SITE ADDRESS STREET,CITY,Z,P CODE m T 01 aruuWd,- A603JJ V5� m 0 & a Sovi tµ� D tAl BY: — " rn NAME OF DESIGNER PHONE C 01 Lawrence Purdum 253-509-2579 1 NAME OF INSTALLER PHONE -• ha Josh Peterson / Kat Trax 253-255-6799 IN CHECK ALL APPLICABLE ITEMS DRINKING WATER SOURCE 0 NEW CONSTRUCTION ❑ RV HOLDING TANK ONLY m PRIVATE INDIVIDUAL WELL Or- O REPLACEMENT SYSTEM 0 INSTALLATION PERMIT ONLY ❑ PRIVATE TWO-PARTY WELL 0 O O TABLE 9 REPAIR 0 SINGLE FAMILY ❑ COMMUNITY/PUBLIC WATER SYSTEM In 1 ® TANK(S)ONLY 0 COMMERCIAL SYSTEM NAME. ❑ UPGRADE TO EXISTING 0 OTHER'. BEDROOMS LOT SIZE 1 ❑ EXISTING FAILURE -Record Drewingregulred 2 20,106 sq ft co 1 wren lnsleueuonC r r 0 DIRECTIONS TO SITE.BE SPECIFIC AND ADVISE OF ANY NEEDED INFORMATION FOR ACCESS(ex lacked gate) Property has locked gate, but able to walk around. Contact property owner otherwise. x b b CS SITE MUST SE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS 1 OFFICIAL USE ONLY BELOW THIS LINE- —"" UPGRADE I FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT (]HOME SALE ❑COMPLAINT 0 OTHER. INSPECTOR SOL LOGS COMMENTS I CONDITIONS SOIL CODES. V=VERY G=GRAVELLY S=SAND L=LOAM Si=OLT CT CLAM E=EXTREMELY R=RUGS 2 INSPECTOR SIGNATURE DATE APPLICATION zozELi APPLICATI 1 PRO [0/ 0(?CATE THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015 DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 1 0 5 -- 5 1 _ 0 0 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. a 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"A /7" PARCEL IDENTIFICATION Permit Number SW'G 2oZ310 45Z Designers Name: Lawrence Purdum Applicant's Name: Nathaniel Lea Designer's Phone Number 253-509-2579 Mailing Address: 12055 Banner Rd SE Designer's Address: PO Box 801 Olalla, WA 98359 Gig Harbor, WA 98335 City State Zip City State Zip DESIGN PARAMETERS Treatment Device 0 Glendon Biofilter 0 Sand Filter ❑Mound 0 Sand Lined Drainfield 0 Recirculating Filler,Type: ®Aerobic Unit Make/Model NuWater BRN500 0 Disinfection Unit Make/Model Other: Drainfield Type El Gravity 0 Pressure ❑Trench 0 Bed 0 Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 2 Schedule/Class N/A Daily Flow: Operating Capacity 240 gpd Length N/A ft Daily Flow: Design Flow 180 gpd Diameter N/A in Septic Tank Capacity N/A gal Number N/A Receiving Soil Type(1-6) N/A Separation N/A ft Receiving Soil Appl. Rate N/A gpd/ff Orifices Required Primary Area N/A if Total Number of Orifices N/A Designed Primary Area N/A ft' Diameter N/A in Designed Reserve Area N/A ft2 Spacing N/A in Trench/Bed Width N/A ft Manifold Trench/Bed Length N/A ft Schedule/Class N/A Elevation Measurements Length N/A ft Original Drainfield Area Slope N/A % Diameter N/A in New Slope,If Altered N/A % Preferred manifold configuration used? 0 Yes 0 No Depth of Excavation Up-slope N/A in Transport Pipe from Original Grade Down-slope N/A in Schedule/Class ASTM D 3034 Designed Vertical Separation N/A in Length AS REQUIRED ft Gravelless Chambers Required? ❑Yes 0 No 0 Optional Diameter 4-IN in Pump Required? 0 Yes 0 No Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day N/A Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity N/A gal Orifice N/A ft Chamber Capacity N/A gal Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required. Capacity(a.Total Pressure Head N/A gpm OTimer OElapse Meter 0 Event Counter Calculated Total Pressure Head N/A ft If Timer: Pump on Pump off A C �e' I' % i7:rr Comments ro -, tg L . ;t,^ Tank replacement only OCT 302023 . _NTY t NM_NThLHEALTu fl l A DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 2 1 0 5 -- 5 1 __ 0 0 0 2 0 Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch O Test hole locations ® Drainfield orientation and layout Reference depth from original grade: ❑ Soil logs ❑ Trench/bed dimensions and ❑ Septic tank Property lines critical distances within layout ❑ Drainfield cover Existing and proposed wells ❑ D-BoxNalve box locations Reference depth from original grade within 100 ft of property ® Septic tank/pump chamber and restrictive strata: Dal Measurements to cuts,banks,and locations ❑ Laterals,trench/bed, top and surface water and critical areas ❑ Observation port location bottom ❑ Location and orientation of ❑ Clean-out location ❑ Curtain drain collector curtain drain and all absorption ❑ Manifold placement ❑ Sand augmentation components ❑ Orifice placement Other cross-section detail: al Location and dimension of ❑ Lateral placement with distance ❑ Observation ports/clean-outs primary system and reserve area to edge of bed l Buildings g Other Information ❑ Audible/visual alarm referenced Yes No ❑ Direction of slope indicator al Scale of drawing shown on scale ❑ al Design staked out al Waterlines bar ❑ al Recorded Notices attached ® Roads, easements,driveways, ❑ ®Waiver(s) attached parking ❑ ® Pump curve attached ® North arrow and scale drawing ml ❑ Evaluation of failure shown on scale bar Non-residential justification ❑ ❑Waste strength O ❑ Flow DESIGN APPROVAL The undersigned designer must be notified by installer at time of installation Yes ❑ No 41 9l28/23 Signature of Designer Date The undersigned has reviewed this design on behalf of Mason County Public Health and determi rb compliance with state and local on-site ulations: (08,6j Gz --, OCT 3 0 2023 Environmental Health Specialist Date . ,; ,,,,,.. CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITIOYQ,M ✓ The design is stamped"Approved"by Mason County Public Health. > / ✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: I Q 1 ZJ l7 W Z y ✓ 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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