HomeMy WebLinkAboutSWG2023-00440 - SWG Application / Design - 10/27/2023 MASON COUNTY 415 N 6TH STREET,SHELTON, ,,WA 00 984
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SHELTON: 42 T EXT967 84
oa 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: SWG2023-00440
APPLICANT WOOD BRITTANY Phone: 360-731-6294
Address: P 0 BOX 1088 BELFAIR, WA 98528
OWNER WOOD BRITTANY Phone: 360-731-6294
Address: P 0 BOX 1088 BELFAIR, WA 98528
SEPTIC DESIGNER Jim Zimny -Advantage Perc & Design Phone: 360-516-7287
Address: 7178 WINDFLOWER PL NW SEABECK, WA 98380
Site Address: 111 NE Ridgetop Ct
Primary Parcel Number: 123194250020
Permit Description: 3-bedroom gravity system
Permit Submitted Date: 10/17/2023
Permit Issued Date: 10/31/2023
Issued By: David Anderson
Current Permit Fees Paid: $535.00 (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 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
MASON COUNTY DATE RECEIVE>: 1 0 / 1 1.i i)?..,.,..
I COMMUNITY SERVICES AMOUNT RECEIVED: ��"��` pc-C� _^� ,,ll co m
:.r '� $ow v inn
Public Health(Community Health/Environmental Health) C ( C
15N.360-427-9670,6 a t 400-Shan,360-275-4467,ext 400 SWG G _ O V 4 Lk� O X
415 N.6th Sheet-Shelton,WA 98584 �(`�2
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION z
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APPLICANT PHONE m
Brittany Wood 360-731-6294 z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE W
PO Box 1088 Belfair WA 98528 Mg VI
SITE ADDRESS-STREET,CITY,ZIP CODE
xi
111 NE Ridgetop Ct , Belfair wa 98528 -1 OCT 17 2023 L 1 —
NAME OF DESIGNER PHONE
li Jim Zimny 360 516-7287 BY: I r..),
NAME OF INSTALLER PHONE a I\,�1
DRINKING WATER SOURCE 6 I~_
PERMIT TYPE(select one) 0
lid RESIDENTIAL OSS fl COMMUNITY OSS rl COMMERCIAL OSS hr-PRIVATE INDIVIDUAL WELL g PRIVATE TWO-PARTY WELL Z I ( J
�
TYPE OF WORK(select one) I_T PUBLIC WATER SYSTEM r
liq NEW CONSTRUCTION/UPGRADES n REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I_c
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
DESIGN FORM(REQUIRED) PI SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE CO
WAIVERS F APPLICABLE) 3 5.03 Acres I N
O� X I( Aq
DIRECTIONS TO SITE AND SITE CONDITIONS (ex locked gate) 1
I From Belfair travel down Northshore Rd .9 miles and take rt on sand hill rd. travel 1.5 miles I
to Ridgetop Ct on rt. Go down 200 yards to lot on Left. follow pink Ribbons to the test holes. ( Q
0
1- IN
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS I a
OFFICIAL USE ONLY BELOW THIS LINE
if
UPGRADE/FAILURE SOURCE(for reporting purposes)
0 VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT OHOME SALE ❑COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
Tfri 675(
fe54 q4 36 I' v/ fill 4 S indrr, L-oIe,/r
ll
iHZ 0 -35 r�I(IC
3SI,
No S
i t13: 0 -35' 65L
Re5d- q# 35V 1/`'/ liel1
RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSPECTOR GNATURE DATE APPLICATION EXPIRATION DATE APPLIC ON APPROVED/ISsIIED BY DATE
O( /? /1o1) IO/?i/z076 (O/3/ 'ZoZ3
THIS FORM AY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
a
DESIGN FORM—PAGE ONE Assessor's Parcel Number. 123194250020- —
A design will be reviewed when 3 conies 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. 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 "Y 17"
PARCEL IDENTIFICATION
Permit Number: SWG - Y o u A . Designer's Name: Jim Zimny
Applicant's Name: BRITfAnY WOOD 360 516 7287
Designer's Phone Number:
Mailing Address: PO Box'088 Designer's Address: 71778 Wndflower Pi NW
BELFAIR WA98628 Seabeck WA 98380
CI FAR FC)RM
City State Zip City State Zip
DESIGN PARAMETERS
i Treatment Device
❑Glendon Biofilter 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
Gravity 0 Pressure E(Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drain-ield Specifications / Laterals
/
Number of Bedrooms 3 Schedule/Class 3034
/
Daily Flow: Operating Capacity 270 gpd Length 50 ft
Daily Flow: Design Flow i 360 gpdI Diameter 4 in -
Septic Tank Capacity (working) 1200 gal/ Number 4 ,
Receiving Soil Type(1-6) 4 Separation 5 CTC ft .
Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices
Required Primary Area 600 fly Total Number of Orifices N/A
't
Designed Primary Area 600 ft2 Diameter t4 in
Designed Reserve Area 600 ft2 Spacing I 4° ns, in
Trench/Bed Width 3 ft / A ` "�l �#. • anifold
Trench/Bed Length 200 ft Sched.'r ,; tst• N/A
o J 1
•
Lic ... , ft
Elevation M asurements Len •..... . ,,,,,�t
E.p re.. �1 1 1....i..., in
Original Drainfield Area Slope 10 % Diameter
New Slope,If Altered 10 % Preferred manifold configuration used? 0 Yes ❑No
Depth of Excavation up-slope 15 in 7 Transport Pipe
from Original Grade Down_sl•,. 12 in Schedule/Class 3034 ,.-
Designed Vertical Separation ` 18 in' Length
20 ft
Gravelless Chambers Required? 0 Yes 0 No reOptionral Diameter 4 in
Pump Required? ❑Yes PS No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
Diff. in Elevation Between &Uppermost Orifice ft Dose quantity gal
Drainfield Squirt Height/Selec Residual(head) ft Chamber Capacity (flood) gal
Pump controls: Please check those required.
Uppermost Orifice 0 Higher ❑Lower than Pump Shutoff
Capacity G Total Pressure Head gpm ❑Timer ❑Elapse Meter 0 Event Counter
Calculated Total Pressure Head ft If Timer: Pump on ,Pump off
Comments L w! L '-,ti.. .Vvf ;:,/'
OCT 3 1 2023
MASON COUNTY ENVIRONMENTAL HEALTH
DJA
•DESIGN FORM—PAGE TWO Assessor's Parcel Number. 123194250020— —
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
let Test hole locations Fl Drainfield orientation and layout Reference depth from original grade:
El Soil logs Lot Trench/bed dimensions and V Septic tank
e( Property lines critical distances within layout B Drainfield cover
O Existingand proposed wells VD-Box/Valve box locations
p P Reference depth from original grade
within 100 ft of property 0 Septic tank/pump chamber and restrictive strata:
El Measurements to cuts,banks,and locations Et Laterals,trench/bed,top and
surface water and critical areas V Observation port location bottom
✓ Location and orien to of ❑ Clean-out location 0 Curtain drain collector
curtain drain and all : •sorption 0 Manifold placement ❑ Sand augmentation
components 0 Orifice placement Other cross-section detail:
El Location and dimensi• 'of e f Lateral placement with distance 0 Observation ports/clean-outs
primary system and : rye area to edge of bed
8 Other Information
e( Buildings
0 Audible/visual alarm referenced Yes No
le Direction of slope in• c r WC Scale of drawing shown on scale 0 Er Design staked out
FT Waterlines bar 0 0 Recorded Notices attached
✓ Roads,easements,dri : ays, A++ L°1 0 Waiver(s)attached
parking s ,�+i CI CIPump curve attached
El North arrow and seat • •wing �tIz++� 0 ❑ Evaluation of failure
shown on scale bar o N4 Non-residential justification
.33 F+ ❑ 0 Waste strength
i LICE • 0 DEsiG/ R
••••I; , • %%%%%` ! 0 in Flow
ESIGN APPiO TAL
The undersigned designer st be notified b ler at . of installation E1 Yes ❑ No
-lDr- y- 2.5
Signature f igner Date
The undersigned has revi= ed this design on behalf of Mason County Public Health and determin l;ac• in
compliance with state and local on-si ulations: ;.► / •
ocr
vironmental Health Specialist ate 3i,lop
b'
CAUTION: DESIGN • PPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITI !,,, ,V/,IE,,,�, `�
✓ The design is stain•- "Approved"by Mason County Public Health. // -„4.471,
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: /0/ ?6/762‘✓ Drainfield site conditi iris 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 Fe is required.
This form may be scannell and available for public view on the Mason County Web site.
ted Date: 12/7/2015
Advantage Perc & Design
Timely•Reasonable•30 Years of Local Experience
Construction Notes for 3 Bedroom Gravity System
Gravity w/graveless chambers (Rock and pipe may be substituted)
Install 4-50' Laterals .
Use a 6 hole d-box and speed levelers
Install on 5'foot centers.
Install 12"trench depth on low side of trench and maintain 18" of vertical separation
Install level and along contours.
Install in dry weather only.
Use 1200-Gallon septic and add risers for pumping and maintenance +1
System designed for typical residential waste strength sewage only. 1 4,; I',
System designed for 360 Gallons Per Day I
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pLICENS Fr SIGNER 1
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Expire=8/I7,M1
OCT 3 12023
MASON COUNTyENVJRONMENTAi HE
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