HomeMy WebLinkAboutSWG2023-00313 - SWG Application / Design - 7/26/2023 at ; MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
BELFAIR.360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00313
APPLICANT GOMEZ-MIER ET UX JOSE LUIS Phone:
Address: NANCY GERALDINE GONZALEZ SHELTON,WA 98584
OWNER GOMEZ-MIER ET UX JOSE LUIS Phone:
Address: NANCY GERALDINE GONZALEZ SHELTON, WA 98584
SEPTIC DESIGNER Bob Paysse -Pioneer Digging Inc Phone: 360-426-1803
Address: 3083 E Mason Benson Road GRAPEVIEW,WA 98546
Site Address: 9220 SE Lynch Rd
Primary Parcel Number: 220295099043
Permit Description: New SFR- 5BR Gravity
Permit Submitted Date: 07/26/2023
Permit Issued Date: 10/09/2023
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system)_
Permit Expiration Date: 08/29/2026 Rased 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 Drainfield 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.
OFFICIAL USE ONLY
DATE RECEIVED.
- MASON COUNTY
COMMUNITYSERVICES °°"T RECEIVED """`DR" II D m
PubicHealth(Com muryHealth/Environmental Health) y E
415.e110SIAr ,eap..(sare. SWG a0:23 - 0693.k3 z 2
ON-SITE SEWAGE SYSTEM APPLICATION > z
m O
PPucANr
PHONE m
JOSE LUIS GOMEZ-MIER 863-244-0854 c
MAILING ADDRESS-STREET.CITY STATE ZIP CODE C
155 E DELANTY RD SHELTON WA 98584 m
13
SITE 6E O SE LYNCH
DDE
522 ROAD SHELTOn VLI9 98584 ' I�F" •
NAME OF DESIGNER PHONE I N
ROBERT H. PAYSSE 360-426-1803
NAME OF INSTALLER PHONE 0 I c'
TBD R
y IN
PERMIT TYPE(re/ecbre/ DRNNKNO WATER SOURCE 0
JMRESIUENTIAL OSS (C pCOMMUNITY OSS I (COMMERCIAL OSS W.PRIVATE INDIVIDUAL WELL b-PRIVATE TWO-PARTY WELL 2 ILfl
TYPE OF WORK(seAsclone) y PUBLIC WATER SYSTEM
PE
ryI NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select all marappM 0 TABLE IX REPAIR IDr
SUBMITTA.S ❑ SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE
pp
L DESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE I0 6WAIVER(S)OF APPLICABLE) 5 5.76 n r
,c,.,IONS TO SITE AND SITE CONDITIONS (ex locked gale) .i I
- •
DOWN ARCADIA ROAD TO RIGHT ON LYNCH RD. TURN LEFT OFF LYNCH @ I I m
MAILBOXES 'r8312" (DRIVE BEFORE APPLICANT). FOLLOW DOWN TO PDI SIGN rr 10
THEN TURN RIGHT AND FOLLOW GREEN RIBBONS TO D/F. -
A
SHE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I (A)
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(Iorrryoflg purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ❑COMPLAINT ['OTHER'.
INSPECTOR SOIL LOGS oNME TS/COND S
/7 UI � 'r I I...
0,10L5 �55O A,,.
ILI 26 2A29
Ir _
RECORD DRAW WG AND INSTALLATION REPORT
SOIL CODES: REQUIRED FOR FINAL APPROVAL
V=VERY G=GRAVELLY S=SAND L=LOAM SI=SILT C=CLAY E=EXTREMELY R=ROOTS
CT,RGNATURE
DATE APPLICATION EXPIRATION DATE A !CATION APPROVED/ssIED BY -0A'E
T I' MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7Q015
DESIGN FORM-PAGE ONE Assessor's Parcel Number: 2 2 0 2 9 - 5 0 - 9 9 0 4 3
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 plotplan,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. Lluximum paper size: II' .k 17-
PARCEL IDENTIFICATION
Permit Number: SWG D-0 -3'oO3i j Designer's Name: ROBERT H.PAYSSE -
JOSE LUIS GOMEZ-MIER 360-26-1803
Applicant's Name: Designer's Phone Number:
Mailing Address: 155 E DELANTY RD Designer's Address: 3083 E MASON BENSON RD
SHELTON WA 98584 GRAPEVIEW WA 98546
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device
❑Glendon BiuFlter 0 Sand Filter 0 Mound 0 Sand Lined Drainlield ❑ Recirculating Filter. line:
❑Aerobic Unit .MakGModel 0 Disinfection Unit Make/Model Other:
Drainfield Type
RIGravity 0 Pressure 1f Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 4.OFFICE(120 GO) Schedule/Class 2729 PERF
Daily Flow: Operating Capacity 450 gpd Length 50 ft
Daily Flow: Design Plow 600 gpd Diameter 4 in
Septic Tank Capacity(working) 2250 gal Number 5
Receiving Soil Type(1-6) 3 Separation 9.5 ft
Receiving Soil Appl.Rate 0.8 gpd/ft2 Orifices
Required Primary Area 750 if Total Number of Orifices -
Designed Primary Area 750 ft2 Diameter - in
Designed Reserve Area 750 ft2 Spacing _ - in
'french/Bed Width 3 ft Manifold
Trench/Bed Length 250 it Schedule/Class 3034
Elevation Measurements Length 40 ft
Original Drainfield Area Slope 15 % Diameter 4 in
New Slope, If Altered 15 % Preferred manilbld configuration used? gYes 0 No
Depth of Excavation Up-slope 13 in Transport Pipe
from Original Grade Dona-slope 7 in Schedule/Class 3034
Designed Vertical Separation 36+ in l.ength <50 ft
Gravelless Chambers Required? 0 Yes it No 0 Optional Diameter 4 in
Pump Required? ❑ Yes lifNo Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day -
Diff in Elevation Between Pump&Uppermost Orifice - It Dose quantity - gal
Drainfield Squirt Height/Selected Residual(head) - ft Chamber Capacity(flood) - gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @A Total Pressure Head - gpm OTimer •El.'se Meter 0 Event Counter
V
Calculated Total Pressure Head - ft If Timer: Pump on P f:' p e
Comments — ', 7l1
OCT 0 9 2023 1�
MASONcar,/-,, .. r !ICqLm
Jaw
--i7ESICN FORM—PAGE TWO Assessor's Parcel Number: 2 2 0 2 9 -- 5 0 -- 9 . 9 0 4 3
Permit Number: SWG
DESIGN CHECKLISTS
I Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch- - " j
' - g Test hole locations g Drainfield orientation and layout Reference depth from d o,a-'..-
O Soil logs 61 Trench/bed dimensions and g Septic tank
O Property lines critical distances within layout 1 Drainfield cover
1 Existing and proposed wells g D-Box/Valve box locations Reference depth from original grade
within 100 ft of property g Septic tank/pump chamber and restrictive strata:
Measurements to cuts, banks, and locations g Laterals,trench/bed,top and
surface water and critical areas g Observation port location bottom
Pli Location and orientation of g Clean-out location 0 Curtain drain collector
curtain drain and all absorption 64 Manifold placement fd Sand augmentation
components
12i Orifice placement Other cross-section detail:
Location and dimension of g Lateral placement with distance _ -.R1.-'01?seFrdtion:ports/clean-outs
primary system and reserve area to edge of bed Other Intonaation ...
6.1 Buildings g Audible/visual alarm referenced Ycs No
▪ Direction of slope indicator 64 Scale of drra ii no o le M 0 Design staked out
61 Waterlines Ai) P ,VI li'6a ❑ 2f Recorded Notices attached
O Roads,easements,driveways, ❑ g Waiver(s)attached
- parking OCT u y 2023 0 l;d Pump curve attached
fga North arrow and scale drawing ❑ 12 Evaluation of failure
shown on scale bar MESON CCU"iTY EWNIFGN:',E,N IAL nEFLTd Non-residential justification
JBW ❑ 1I Waste strength
❑ g Flow
DESIGN APPROVAL • ,s s r.mit^,q port, clew .._
The undersigned designer m be notifiec y installer at time of installation 164 Yes ❑ No - . -. . - -
ti P 71 714Q ' z3
ignature of est er Date
The undersigned has reviewed this design on behalf of Mason County Public I leallh and determined it to be in
pempliance with state and locr on lte regulations:
A --`� la -'t-25
�16 :Ai ental Health Specialist Date
CAUTION: DESIGN APP OVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
1.---The design is stamped"Approved" by Mason County Public Health. — /._------
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: 2`/ -20
✓ 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
I '
\ y DESIGN FOR RESIDENTIAL
� �Cy PURPOSES AND AHOME
kr-, OFFICE WITH UPTO3
\ EMPLOYEES (120 GPD MAX).
\ EXPECTED TO WASTE STRENGTH
BE WITHIN
RESIDENTIAL LEVELS (NOT
I HIGH STRENGTH)
MAINTAIN 10'+ I EXISTING
BETWEEN POTABLE HOME 1 WATER AND SEWER I SHARED DRIVEWAY
LINES
//\\ \ SEPTIC TANK
\\ I (SEE OTHER PERMIT)
FUTURE OFFICE . ( \ 1
W/ 3 EMPLOYEES 1 1
\ / i
+I
NOTE: \ EXISTING
BEWARE OF ` WELL
EXISTING2" 0I EXISTING
TRANSPORT LINE I SIPHON TANK
GOING TO FUTURE
COMMUNITY HOME SEE/
DRAINFIELD / NO
LOCATIONXISTING COMMUNITY
IPHON 055 FROM 11/21/94
EE COUNTY RECORDS
INSTALL CLEANOUTS
ON SEWER LINE AS 18 BEDROOMS W/ RESERVE
NEEDED I BETWEEN PRIMARY
(\AF/5 CDNNEC110R ON 1!115 VI.0.MI1)
PROPOSED PRIMARY P ® r �°
Ez RESERVE W/ 2250
GAL. SEPTIC TANK + °C li 3 2023 D
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AN ASBOILTI INSTALL SIGNOFF FEE WILL
BE CHARGED AT TIME OF INSTALLATION
PIONEER DIGGING, INC "`TOMER JOSE LIB°O1"EZ 0L<I9q1>Id E I, 2
A11-P.SRCR s12(Y24509 Oi-4 19043 1..I: FR
SEPTIC ENSIGN', .vDDRLti- 8220 SE LYNCHRD Ic.
a)s3 n1ncV AL_')N RD. CRAlFYIDA Fk F vxs It DEICAIR- ROBERT H.PATSSE
FFI<F 36u 426 IS13 I:4C )00+2E 2353 SI IEFT. SITE PLAN SCALE I'=100 o, N.TNNw, •,NFc" ,E ,Ns.aa.S.Pr..Ro
AN ASBUILT/INSTALL SIGNOFF FEE WILL
BE CHARGED AT TIME OF INSTALLATION
0 P-BOX
W/ ACCESS TO
FINISHED GRADE
0
2250 GALLON •
SEPTIC TANK
4" 3034
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OBSERVATION
PIONEER /�/� NC. PORTS (X5)
DIGGING, I OW R: LOSE LUIS GOMEZMIFA L I I I:I F I L, H.�LE 2
rARL FI-e.22029-50-99043 /Ne
r ol> 57 itooN >>
Si PI IC DESIGNS vDDRFs: 8220 SELYNOID
3083E NI35J]BEN30 yEin. CRAPFVIEA 5%59851P DESIGNR: ROBERT IL PAYSSE
OLFCL 330 1201803 FAC-30P4272353 SHLLI: DF DETAIL SCALE I' G E=LA sK E°
OBSERVATION
PORT FINISHED
b „t GRADE
COVER
ORIGINAL GRADE
FILTER
FABRIC
t
WASHED
ROCK RISER/LID TO
FINISHED
GLUED TEE r
GRAPE
M a a
RESTRICTIVE
LAYER
D-BOX - L° H
USE SPEED A LEVELERS TO PPR ® VE
EQUALIZE OCT 0 9 2023
FLOWS ,S NCJCKIlE^ILrn ,I-,_A_HEA
'i• LJ, CF.
SOB W
AN ASBUILTI INSTALL SIGNOFF FEE WILL
BE CHARGED AT TIME OF INSTALLATION
( LIS I.`h11 A: JOSE LULS GOMEZ-MIER IE:I IIJII II ;I I I:I I
PIONEER DIGGWG, NC 1'vIU. II 22029-5099043 L"II", ",
SEPTIC DESIGNS vDDRF S: 8220 SE LYNCH RD
30831 ul"=\BL. ,N Eo IA AI I\IF .a;>OH DEER:\FR: KOBERT H.PAYSSEEATS OR SERVES'S FIE MEASSIRENENTESNO BONNE,EIS OES N ENDED FOB NEI IS
EJSPOSE5 LSO ERISEUS.D [BYE ELIABSIT SW BE SASES" EC STEER
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installation & System Notes
1. Installer must contact designer for final inspection of the installation prior to cover. All components, including tanks, lids,
transport line,drainfield,and water lines must be open for inspection. A$350.00 fee will be charged for time involved with the
inspection of the installation and creation of the record drawing. The designer reserves the right to charge additional fees if
multiple visits are needed due to installation errors or inaccessible components.
2.This septic design must be installed by a certified installer with the local health department. All components shall be installed
according to state,county,and manufacturer requirements. For Homeowner Installs,the owner must get approval from the
designer and local health department prior to attempting installation.
3. Designer is not a surveyor. Installer must familiarize themselves with property line locations prior to installation. Any
confusion or conflicts with line locations should be reported to the property owner. A licensed surveyor may be necessary prior
to installation to confirm all line locations. Any discrepancies found must be reported to the designer immediately.
4. Drainfield area may only be cleared by a licensed installer familiar with sensitive drainfield area preservation. The builder, lot
developer,or property owner shall not clear the drainfield area. Any clearing required for drainfield installation shall not
remove or disturb any top soil in Primary and Reserve areas. Removal or disturbance to dra infield soils could render design
void.
5.The property owner and installer are responsible for locating all underground utilities(ex. water,gas, electric) prior to
installation. Any utility locations shown within design drawings are likely approximate and may not be exact.
6. All proposed tanks must be installed on original soils or compacted gravels. Extend all tank connection lines out onto original
soil to avoid settling issues. Risers and lids must be brought to finished grade and left accessible for future operations and
maintenance. Component manufacturers (ex. ATU,Glendons,) may have other requirements not listed within this design.
7.All electrical wiring shall be done by a licensed electrician or homeowner(if allowed)and must be permitted through Labor
and Industries.
8.The proposed septic system should be installed in dry weather conditions. Any failed attempts at installation during wet
weather conditions may render this design void.
9. Maintain 10ft to waterlines with all septic components. If less than loft is required, sleeving in sch.40 pvc is required. If
sewage transport lines and waterlines must cross,waterline must be 18" above sewage line with one of the lines sleeved in sch.
40 pvc loft in each direction of crossing.
10.This design may include waiver applications with specific mitigation measures pertaining to installation,operation and
maintenance of the proposed components.
11.Stormwater runoff,footing drains, roof drains must be diverted away from any septic system components. No curtain,
foundation, perimeter drains shall be installed 30ft downslope and loft upslope of drainfield areas.
12.This design is site specific and intended to meet state and county requirements that are related to the system components
being proposed. Any placement of proposed buildings,proposed wells or other non-related items on these drawings mayor
may not meet other requirements.
13.All onsite septic systems require regular maintenance to verify satisfactory operation. The system owner/operator is
responsible for the continuous operation and maintenance of the system per WAC 246-272A. For operation and maintenance
information, refer to Mason County Public Health Homeowner's Manual,which should be received after installation approval.
14.System owner should be cautious of landscaping around septic com onents. Rooto intrusionin
can cause premature failure of the drainfield area. In addition, b s P� VI YeEp
away from lids and other septic maintenance points. FFZ
OCT 0 9 2023
W.X.
PIONEER DIGGING, INC c llsi o��1I R:JOSE LUIS GOMEZ-MIER o-f • �: •
P VLL.I I.e 22029-5099043 _ e ;
SLI'I ICI DI'SIGNS ADDRESS: 8220 SE LYNCH RD I rcr'ri %�• `,
3083 F wfioN BFAPON RD. CR VPFVIRV,wA 98546 DESIGNER: ROBERT FL PAYSSE
Of HCE-3NN2U-I801 FaV-3c -1272353 SHI I I: NOTES SCALE NA