HomeMy WebLinkAboutSWG2023-00456 - SWG Application / Design - 10/23/2023 MASON COUNTY 415N 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: SWG2023-00456
APPLICANT Tuesdee Messer Phone: 253-514-7473
Address: 1680 NE Old Belfair Hwy ALLYN, WA 98524
OWNER GILCHRIST DESIREE Phone:
Address: 1670 NE OLD BELFAIR HWY BELFAIR, WA 98528
SEPTIC DESIGNER Jim Zimny -Advantage Perc& Design Phone: 360-516-7287
Address: 7178 WINDFLOWER PL NW SEABECK, WA 98380
Site Address: 1670 NE Old Belfair Hwy
Primary Parcel Number: 123174300090
Permit Description: 3-bedroom gravity system
Permit Submitted Date: 10/23/2023
Permit Issued Date: 10/31/2023
Issued By: David Anderson
Current Permit Fees Paid: $525.00 (additional fees may be required upon instauadon of system).
Permit Expiration Date: 10/26/2026 (based on date or 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.
OFFICIAL USE( —
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MASON COUNTY DATE to �3 g Ja m a
COMMUNITY SERVICES L c
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION z
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PPPUCANT PHONE m
Tuesdee Messer 253-514-7473 I-
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MAILING ADDRESS-STREET CITY.STATIC ZIP CODE
1680 Old Belfair Hwy, Belfair Wa 98524 m
71
SITE ADDRESS-STREET CITY ZIP CODE
1689mOld Belfair Hwy, Belfair Wa 98524
NAME OF DESIGNER TFINE
JIM ZIMNY 360 516-7287 I ri
NAME OF INSTAL LFR PHONE O I ^+
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PERMIT TYPE fmNd ) DRINKING WATER SOURCE VI
A RESIDENTIAL OSS el COMMUNITY OSS iI COMMERCIAL O55 b PRIVATE INDIVIDUAL WELL 19 PRIVATE TWO-PARTY WELL 2 I' 1
TYPE OF NORK gam one) 3 PUBLIC WATER SYSTEM
in NEW CONSTRUCTION I UPGRADES II REPAIR I REPLACEMENT OTHER DE TAILS fsSee all WI epp 0 TABLE IX REPAIR I T—
SUBMITTALS ❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE W `I
I(DESIGN FORM(REQUIRED) MI SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE O IV YI
5 WAIVER(S)(IF APPLICABLE) 3 40779 SG FT n I t
DIRECTIONS TO SITE AND SITE CMdTIONS(a baked Mel 7 G
FROM BELFAIR TAKE OLD BELFAIR HWY 3.1 MILES TO SITE ON RT MARKER W/ I O
ORANGE SIGN AND PINK RIBBONS. FOLLOW RD TO GATE( GATE OPENS 10
TOWARDS THE RD. TEST HOLES ARE TO THE LEFT OF GATE AN re . 1 o
PINK RIBBONS 1 KeL/4I V `� 11 I_n
R GCS
SITE MUST BE FLAGGED FROM PAIN ROAD AND TEST HOSES MUST BE FLAGGED WITH TEST HOLE M/YBER&
OFFICIAL USE ONLY BELOW THIS LINE BY: _____
UPGRADE I FNLURE SOURCE, for reprbr9 Wmoses)
❑VOLUNTARY 0 MAINTENANCE/PUMP1NG 0 BUILDING PERMIT [NICME SALE ['COMPLAINT CI OTHER:
INSPEC FON SOIL LOG `1 COMMENTS I CONDITIONS
0
71l1 : 0 - 4\2 5
IVO f
701: 0- bQ YES
(Vo fQS}
rift a- 56' 1 Vvt4S
Iry fps)
SOIL CODES: RECORD ORMMNG AND INSTALLATION REWRT
V=VERY G=GRAVELLY 5=SA D L=LOAM S=SILT C=CLAY E=EXTREIAELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSPECTO SIGNATURE./ DATE APPLICATION EXPIRATION DATE AWUCAT APPROVED/ISSUED BY DATE
,r 10/261 L0L3 /0/16/b 26 &L /0/3//2o23
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVivn l;n!3e,5
DESIGN FORM-PAGE ONE Assessor's Parcel Number. 12317-43-00090 -
A design will be reviewed when 3 mo'Igof each of the following an submitted:
Completed design form that has been signed and dated to Scaled layout sketch,including all applicable items on checklist
Scaled plot plan,including all applicable items on checklist 0 Cum -section sketch including all applicable hens on checklist.
This form may be scanned and available for pubic view on the Mason County Web Ste.Maximum paper size: 11'X I7"
�1 r� PARCEL IDENTIFICATION
Permit Number. SWG a1/a.-)j' DO*5 b Designer's Name: Jim Timmy
360
Applicant's Name: —ruesdct et CR _ Designer's Phone Number: 516-7287
Mailing Adders: 1eso Old BelFair Designer's Address: 7178 Windflmwer pL nw
Bella r WA 98524 Seabed( WA 98380
CLEAR FORM
City State Zip City State Zip
I DESIGN PARAMETERS
Treatment Device
❑Glendon Biofiltcr ❑Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Older.
Drainfield Type
'Gravity 0 Pressure 0 Trench fled 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 3034 i-
Daily Flow:Operating Capacity 270 gpd - Length 45 ft
Daily Flow: Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity(working) 1200 gal ' Number 3
Receiving Soil Type(1-6) Separation 3 ft
Receiving Soil Appl.Rate 0.8 gpd/fl2... Orifices
Required primary Area 450 ftr ' Total Number of Orifices N/A
Designed Primary Area 450 ft ` Diameter -t in
Designed Reserve Area 600 ftr / Spacing r :5n in
Trench/Bed Width 10 ft ai th Manifold
TrenchBed Length 45 ft / Schedule%s n It N/a
Eictr,.
Elevation Measurements le;: ,:/�
ft
Original Drainfield Area Slope 2 % s . c�%�smrl in
New Slope,If Altered 2 % Preferred manifold configuration used? 0 Yes O No
Depth of Excavation upnope 24 in Transport Pipe
from Original Grade oowna�ope 24 in . Scledule/Chass 3034
Designed Vertical Separation 36 in Length 20' ft
Gravelless Chanters Required? ❑Yes 0 No Er Optional Diameter 4 in
Pump Required? ❑Yes ErNo Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
Di 1,in Elevation Between Pump&Uppermost Orifice ft Dose quantity gal
Dminfield 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 @ Total Pressure Head gpm OTimer OElapse Meter 0 Event Counter
Calculated Total Pressure Head ft r: 1 Timer-Ptnup.oa- ,Pump off
Comments
OCT 3127.3
DESIGN FORM—PAGE TWO Assessor's Parcel Number. 12317-43-00090 —
Permit Number SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
e Test hole locations H Drainficld orientation and layout Reference depth from original grade:
H Soil logs H Trench/bed dimensions and 10 Septic tank
H Property lines critical distances within layout i3 Drainfield cover
H Existing and proposed wells er D-BoxNalve box locations Reference depth from original grade
within 100 ft of property H Septic tank/pump chamber and restrictive strata:
H Measurements to cuts,banks,and locations H Laterals,trench bed,top and
surface water and critical areas H Observation port location bottom
H Location and orientation of 0 Clean-out location 0 Curtain drain collector
curtain drain and all absorption 0 Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
H Location and dimension of g Jatrral placement with distance S Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
H Buildings 0 Audible/visual aiann referenced Yes No
H Direction of slope indicator H Soak of drawing shown on scale 0 Et Design staked out
H Waterlines bar Q 0 Recorded Notices attached
H Roads,easements,driveways, ,i'r i7❑ 0 Waiver(s)attached
parking r5� 0 0 Pump curve attached
A'r 0 0 Evaluation of failure
H North arrow and scale drawing i¢� r,
shown on scale bar >od # , Non-residential justification
. er'y ❑ ❑Waste strength
"raSm.�r ❑ ❑Flow
o _ •
ESIGN APPR s •AL
The undersigned designer must be notifie y r ffi time of installation PIYes ❑ No
Signatu o esigner Date
The undersigned has reviewed this design on behalf of Mason County Public Health and del'erned tit tb be:ia
compliance with state and local on-site ations:
Environmental Health Speciali
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. /0/7�/7 76
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: / G
V 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: 12H/2015
----------"AlFtla1/4-5.--N
Advantage Perc & Design
Construction Notes for Gravity Distribution bed for 3 Bedroom System:
Gravity Bed Distribution w/Rock and pipe(graveless Chambers may be substituted)
Install 10 x 45'beds.
Install 4 outlet d-box with an outlet pipe going to each infiltrator leg using speed levelers.
D box must have an access riser to the surface of the ground.
Install 24"deep and level in trench
Install in dry weather only. r` - _
Use 1200 Gallon septic W/water-tight secured risers to the surface of the ground.
System designed for typical residential waste strength sewage only. ITT 7 1 r 717
System designed for 360 Gallons Per Day
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