HomeMy WebLinkAboutSWG2023-00428 - SWG Application / Design - 10/9/2023 A : MASON COUNTY 415N 6TH STREET,SHELTON,WA 98584
SHELTON:360427-9670,EXT 400
BELFAIR'.360-275-4467, EXT 400
Public Health & Human Services ELMA 360482-5269, EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00428
APPLICANT MILLER ROBERT J Phone: 1.360.710.5335
Address: 190 NE TIGER WAY E BELFAIR, WA 98528
OWNER MILLER ROBERT J Phone: 1.360.710.5335
Address: 190 NE TIGER WAY E BELFAIR, WA 98528
SEPTIC DESIGNER TOM WEAVER-Allied Design Inc Phone: 360-620-7054
Address: 3912 STEELHEAD DRIVE NW BREMERTON, WA 98312
Site Address: 211 NE Barbara Ln
Primary Parcel Number: 223365400046
Permit Description: 3-bedroom gravity system
Permit Submitted Date: 10/09/2023
Permit Issued Date: 10/31/2023
Issued By: David Anderson
Current Permit Fees Paid: 5520.00 (additional tees may be required upon installation of system).
Permit Expiration Date: 10/26/2026 (cased 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 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 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.
MASON COUNTY PUBLIC HEALTH I DATE°E ED I fq Z i y a
ONSITE SEWAGE SYSTEM APPLICATION FMODM RECEIVED _
41SN 6th Street,(Bldg B) Shelton WA98584 A O T
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Shelton:31iDJE196)B ext/00 &Ihir.36D115J16I ext 400 SWG _ CO -2 p, E
APPLICANT PHONE > >
Rob Miller 360-710-5335 robmillerl8@outlook.com A
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MAILING ADDRESS-STREET.CITY.STATE.ZIP CODE r-
190 NE Tiger Way E, Belfair, WA 98528 0 c
SITE ADDRESS-STREET Cm ZIP CODE --- n 3
211 NE Barbara Ln, Belfair 98528 A
NAME OF DESIGNER PHONE I N
Thomas Weaver _ 360-620-7054
NAME OF INSTALLER PHONE -
I N
CHECK ALL APPLICABLE ITEMS DRINKING WATER SOURCE O_ COI
R NEW CONSTRUCTION 0 RV HOLDING TANK ONLY 0 PRIVATE INDIVIDUAL WELL Ea
0I 0)0 REPLACEMENT SYSTEM 0 INSTALLATION PERM'I ONLY 0 PRIVATE TWO-PARTY WELL p
❑ TABLE 9 REPAIR ❑ SINGLE FAMILY RI COMMUNITYIPUBLIC WATER SYSTEM Z
❑ TANK(S)ONLY 1 ) 0 COMMERCIAL Upgrade existing SYSTEM NAME I
❑ UPGRADE TO EXISTING 0 OTHER'.Repair with expansion a I
BEDROOMS LOT SIZE (JI
❑ EXISTING FAILURE 'Record 0nW
kw I^M.Bn.IN,„lone
3 .21 Acres rm I a
DIRECTIONS TO SITE BE SPECIFIC AND A VISE OFANY NEEDED INFORMATION FOR ACCESS Iw.lockedylel0
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Take SR 300 from Belfair and turn right onto Larson Lake Rd I o
Turn onto Matthew Dr
Turn left onto NE Barbara Blvd I O
Turn left onto NE Barbara Ln
Lot is near the end of NE Barbara Ln on the left r I o
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SITE moor BE FLAGGED FROM TANN ROAD AND TES HOLES MUST BE FLAGGED M TH TEST HOLE NUMBERS I
T
I UPGRADE I FAILURE SOURCE 11wwPonvq pwppyl
jo VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ❑ROUE SALE QCOMPWNT ❑OTHER
r INSPECTOR SOIL LOGS II ( COMMENTS I CONDITIONS
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! SOIL CODES'
-VERY G•GRAVELLY S=SAND L•LOAM SI=SILT C-CLAY E-EXTREMELY R.ROOTS
Ms Ec O ATURE DATE APPLICATION EXPIRATION DATE APPI CATION APPROVED BY DATE
G /26/Zo?L r /O/3/1zoj
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THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED I¢/7/2015
DESIGN FORM—PAGE ONE Assessor's Parcel Number:2 2 3 3 6 -- 5 4 -- _0 0 Q 4 6
A design will be reviewed when 3 copies of each of the following are submitted:
Completed design form that has been signed and dated. s Scaled layout sketch, including all applicable items on checklist
Scaled plot plan,including all applicable items on checklist. v Cross-section sketch,including all applicable items on checklist.
This form may be scanned and available for public view on the Mason Countyy.Web site.Maximum .o er size 11 A'/7"
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Permit Number: SWG aU1�- VL� �)-n Designer's Name: Tom Weaver
Applicants Name: Rob Miller Designer's Phone Number: 460-620-7054
Mailing Address: 190 NE Tiger Way E _ _ Designer's Address: 3912 Steelhead Dr NW
Belfair, WA 98528 Bremerton WA 98312
City State Zip City State Zip
Treatment Device
❑Glendon Mo611cr 0 Sand Filter 0 Mound 0 Sand lined Drainfield 0 Recirculating Filter,Type:
❑ Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
;ccGravity 0 Pressure 0 Trench 't Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 2729
Daily Flow: Operating Capacity NS 2.70 o `gpd Length 45' fl
Daily Flow: Design Flow 360 gpd Diameter 4" in -
Septic Tank Capacity 1,200 gar Number 3
Receiving Soil Type(1-6) 3 - Separation 40" ft -
Receiving Soil Appl.Rate .8 gpd/ft7 Orifices
Required Square Footage 450 ft'- Total Number of Orifices NA
Designed Square Footage 450 ft' Diameter in
PercenthReduction Wth Taken 0 ft Spacing- L�25 V in
Trencltided Width SDI ft � a fold
Trench/Red length 45' ft , Schedu 7I r:: NA
ACT �i � ' --
Elevation Measurements Length ft
7
Original Drainfield Area Slope % DiameteBY: in
New Slope.If Altered NA % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Ilpslope 24 in Transport Pipe Bf
n-
from Original Grade IAxslope 24 in Schedule/Class 30344k
Designed Vertical Separation 36 in Length 40 ft
Gravelless Chambers Required? 0 Yes g No 0 Optional Diameter 4 in
Pump Required? 0 Yes a(No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses day NA
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity gal
Orifice ft Chamber Capacity gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls: Please check those required.
Capacity ' Total Pressure Head gpm ❑Timer ❑Elapse Meter 0 Event Counter
Calculated Total Pressure Head fl 2 Fn tfi 7mrer(=PtIMP Cffr n.> ,Pump off
Comments I"" "" 'Y "r'^
CC f 3 1 2023
r317EN,AL HEAL H.
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DESIGN FORM-PAGE TWO Assessor's Parcel Number:22 a2ft -- 5A, -- _a a_a A__6
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Qd Test hole locations (1I Drainfield orientation and layout Reference depth from original grade:
X Soil logs t$ Trench/bed dimensions and in Septic tank
Property lines critical distances within layout ❑ Drainfield cover
aa Existing and proposed wells X1 D-BoxNalve box locations
ro Reference depth from original grade
within 100 fi of property IX Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts, banks, and locations )0 Laterals,trench bed, top and
surface water and critical areas CM Observation port location bottom
❑ Location and orientation of IJ Clean-out location 0 Curtain drain collector
curtain drain and all absorption ❑ Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
114 l ocation and dimension of 0 Lateral placement with distance PO Observation ports/clean-outs
primary system and reserve area to edge of bed
t$ Buildings Other Information
p Audible/visual alarm referenced Yes No Top&bottom legs staked
cit Direction of slope indicator ® Scale of drawing shown on scale ❑
(X Waterlines g 69 Designr staked out
bar ❑ � Recorded Notices attached
Roads, easements,driveways. 0 RI Waiver(s)attached
parking I& 0 Pump curve attached
X North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
O 0 Flow
DESIGN APPROVAL
The undersigned designer must/be tified by installer at time of installation ❑ Yes IX No
October 3, 2023
Signature of Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health and det tt.anikto_be in
compliance with state and local on-site lations: 9 y'
%< 70(3/// e OCTji
E i nmental Health Specia ist Datq„
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITI{ -. .
✓ The design is stamped "Approved" by Mason County Public Health. / 7 7
✓ The Onsite Sewage Permit has not expired.the Permit Expiration Date is: ( O///C720-7 ,,
✓ 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.
Revision Date: 1/12,2010
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1 ,200 Gallons
SECURED LID WRH GAS TIGHT SEAL
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FINISH GRADE
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Drawing modified from WSDH RS&G's
D-Box Details
\' Speed levelers inside D-box
1111%, - Use in each leg going to a trench
Inlet pipe comes through 2" higher hole
No speed levelers in inlet pipe
Typical Plastic D-Box for three legs
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