HomeMy WebLinkAboutSWG2023-00438 - SWG Application / Design - 10/17/2023 MASON COUNTY 415"6TH STREET SHE,T 584
JSHELTON: 3Cn4 100
BELFAIR:360 2 400
RF Public Health & Human Services eELMA 3004 400
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On-Site Sewage System Permit: SWG2023-00438
APPLICANT SCHREIBER CHRISTOPHER L& Phone:
MICHELLE T
Address: 350 E AGATE LOOP RD SHELTON, WA 98584
OWNER SCHREIBER CHRISTOPHER L& Phone:
MICHELLET
Address: 350 E AGATE LOOP RD SHELTON, WA 98584
SEPTIC DESIGNER DALE TAHJA-Septic Designer Phone: 360-426-5940
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: UNKNOWN
Primary Parcel Number: 320114400050
Permit Description: New 3bd pressure trench
Permit Submitted Date: 10/17/2023
Permit Issued Date: 11/15/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $780.00 (additional fees may be required upon install en
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 backlit'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 LOCATI! F.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUC1 ..
For Final Inspection visit: masoncountywa.gov/health/environmental/onsiteloss-inspection-reguest.pl. II:
360-427-9670,extension 400.
------- OFFICIAL USE ONLY
DAIIPKDVEO.
MASON COUNTY I (� E� �� c y
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COMMUNITY SERVICES "°fin^F°� Ubr7 I a CO
Pub&Nx&M1(Communl Health/Environmental �C C
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ON-SITE SEWAGE SYSTEM APPLICATION 3 73
APPLICANT PHONE m
Jessica Schreiber (360) 463-4800 c
350 E. Agate Loop MAILING ADDRESS-STREET CITY, TRdPcoDE Shelton WA 98584 M
SITE ADDRESS-STREET CITY..ZIP CODE
E. Agate Loop Rd. Shelton WA 98584 (...'
NAME OF DESIGNER PHONE N
Dale L. Tahja (360) 426-5940
NAME OF INSTALLER PHONE a O
en
PERMIT TYPE(eabd me) DRINKING WATER SOURCE
IP:RESIDENTIAL OSS -COMMUNITY ass ECOMMERCIAL OSS i,I PRIVATE INDIVIDUAL WELL 6:PRIVATE TWO-PARTY WELL 2
17
TYPE OF WORK(select ono) PUBLIC WATER SYSTEM
6J,NEW CONSTRUCTION/UPGRADES [I!REPAIR/REPLACEMENT OTHER DETAILS Gefect aII Tatappq/ 0 TABLE IX REPAIR ?
SUBMITTALSpp q ❑ SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE co
RDESIGN FORM(REQUIRED) ACI SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE 0 a
p..qL,WAIVER(5)(IF APPLICABLE) 3 5 acres F '0
DIREC!IONS-O SITE AND SITE CONDITIONS'.(secs tacked vebl
Go north out of Shelton on Hwy 3, right on Agate Rd., right on Agate Loop Rd., property on o
the right with unlocked metal gate. r- O
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-1
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ME MUST BEFIACOED FROM AWN ROAD ANO TEST HOLES MUST BEFIAGGEO MIN TEST HOLE MLHOLE NUMBERS. 0
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE for repcNnp purposes)
CI VOLUNTARY 0 MAINTENANCE/PUMPING. ❑BUILDING PERMIT ['HOME SALE ❑COMPLAINT ❑OTHEREri'. t
INSPECTOR1T SOILLOGS j COMMENTS/CONDITIONS P /IQ
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RECORD DRAWING AND INSTALLATION REPO' .. J/
SOIL CODES:
V=VERY 0s GRAVELLY Ss SAND I=LOAM Si SILT Cs CLAY E=EXTRFMFI Y R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVEOI ISSUED BY DATE
,,__ `` PP
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE __.. 'T� REVISED 1272015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 0 1 1 — 4 4 — 0 0 0 5 0
A design win be reviewed when 3 conies of each of the following are submitted:
I Completed design form that has been signed and dated. •Scaled layout sketch,including all applicable items on checklist
v 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 tte.Maximum paper size: 11 'X 17"
PA L IDiNTWICAUONi
Permit Number: SWG 2023-00438 Designer's Name: Dale Tahja
Applicant's Name: Jessica Screiber Designer's Phone Number: (360)426-5940
Mailing Address: 350 E.Agate Loop Road Designer's Address: 2450 W Deegan Rd W -
Shelton WA 98584 Shelton WA 98584
City State Zip City Slate Zip
-- DESB6NPANAM "� '
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound ❑Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Mode! ❑Disinfection Unit Make/Model Other: N/A -.
Drainfield Type
❑Gravity hi(Pressure cif Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class Sch.40
Daily Flow:Operating Capacity 270 gpd Length 75 ft
Daily Flow:Design Flow 360 gpd Diameter 1.25 in
Septic Tank Capacity(working) 1,250 gal Number 4
Receiving Soil Type(1-6) 5 Separation 10 ft
Receiving Soil Appl.Rate 0.4 gpd/ff Orifices
Required Primary Area 900 ./ If Total Number of Orifices 76
Designed Primary Area 900 p ft' Diameter 1/8 in
Designed Reserve Area led 100 ft2`a Spacing 48 in
Trench/Bed Width 3 ft r Manifold
Trench/Bed Length 300 ft Schedule/Class Sch.40
Elevation Measurements Length 70 ft
Original Urainfietd Area Slope 5 % Diameter 1.25 in
New Slope,If Altered 5 % Preferred manifold configuration used? 0 Yes RINo
Depth of Excavation Up-slope 10 in Transport Pipe
from Original Grade Do wslope 8 in Schedule/Class Sch. 40
Designed Vertical Separation 24 in Length 10 ft
Gravel less Chambers Required? 0 Yes 0 No l li Optional Diameter 2 in
Pump Required? 56 Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 4
Diff. in Elevation Between Pump&Uppermost Orifice 5 ft Dose quantity 67.5 gal
Drainfield Squirt Height/Selected Residual(head) 6 ft Chamber Capacity(flood) 1,000 gal
Uppermost Orifice ft Higher 0 Lower than Pump Shutoff
Pump controls:Please check those required.
Capacity @ Total Pressure Head 35 gpm SITimer gElapse Meter IiEvent Counter
Calculated Total Pressure Head 15 ft If Timer Pump on 2 min. ,pump oft 5 hrs.58 min.
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 0 1 1 — 4 4 -- 0 0 0 5 0
Permit Number: SWG 2023-00438
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Et Test hole locations 21 Drainfield orientation and layout Reference depth from original grade:
Hi Soil logs PI Trench/bed dimensions and g Septic tank
21 Property lines critical distances within layout Hi Drainfield cover
lid Existing and proposed wells
D-BoxNalve box locations Reference depth from original grade
within 100 ft of property g Septic tank pump chamber and restrictive strata:
m Measurements to cuts, banks, and locations WI Laterals,trench/bed,top and
surface water and critical areas 21 Observation port location bottom
0 Curtain drain collector
6r7 Location and
orientationl of g Claanrouila locatione 0 Sand augmentation
curtain drain and all absorption � Manifold placement
components 66 Orifice placement Other cross-section detail:
m Location and dimension of 66 Observation ports/clean-outs� Lateral placement with distance
primary system and reserve area to edge of bed Other Information
Pi Hi Audible/visual alarm referenced Yes No
m Direction of slope indicator g Scale of drawing shown on scale d 0 Design staked out
g Waterlines bar 0 0 Recorded Notices attached
0IA
0 Waiver(s)attached
Roads,easements,driveways, l6 0 Pump curve attached
parking ❑ 0 Evaluation of failure
North arrow and scale drawing
shown on scale bar Non-residential justification
❑ 0 Waste strength
0 ❑ Flow
DESIGN APPROVAL
The undersigned designer be notified b installer�t time of installation Hi Yes ❑ No
Signature o Designer Date C1.'sva' - -erS
JJJJJJ r
The undersigned has reviewed this design on behalf of Mason County Public Health and deterred 'ful'!O
i ` �, '..
compliance with state and local on-site regulations: ,�''
Environmental Heaaltth''Specialist Date t lb,l i-
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONnk Q A7
V The design is stamped"Approved"by Mason CountyPublic Health. h � ��
Dl �" /� � f�
I The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
✓ Dminfield site conditions have not been altered to adversely affect conditions of design approval. '1.,
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 siteUpdated Date: 12/7/2015
• Mason County WA GIS Web Map
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APPROVED
0 I NOV 15 2923
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Liberty Pumps 280- 1/2 HP Cast Iron Submersible Sump/Effluent Pump (Non-
Automatic)
Performance Curve: 280-Series
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APPROVED
NOV 15 2023
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Installation/Maintenance
Pressure Distribution/Trench Systems
1. Install trench bottom level and in contour with the ground.
2. Install drainfield during dry weather and soil conditions.Any soil smearing must be
eliminated by hand raking any areas that get smeared.
3. Install audio/visual high water alarm.
4. Install effluent filter in septic tank outlet or pump vault with 1/16 inch maximum
filtration mesh size.
5. Install check valve in pump outlet line to prevent back-flow into the pump chamber.
6. Install 1/8 inch orifices on 4ft. centers. Install the orifices (with orifice shields)pointing
straight up ( 12:00 o' clock).
7. Divert all storm water run-off away from septic system components.
8. No curtain(french) drains allowed within l Oft. of the up-slope edge of the drainfield and
reserve area.
9. No curtain (french) drains allowed within 30ft. of the down-slope edge of the drainfield
and reserve area.
10.Have the septic tank and pump chamber pumped or inspected every 3 to 5 years.
11.Inspect and clean pump screen as needed.
12.Inspect floats and test high water alarm every 6 to 12 months or as needed.
13.All material and workmanship must meet County and State requirements.
14.Install risers on septic tank and pump chamber.
15.Deviation from this approved design without prior approval from the Designer and
Mason County Health Department will make this design null and void.
16.The prepared Site Plan is not a survey, it is the owner's responsibility to verify property
line locations prior to installation. Any discrepancies must be reported to the Designer
immediately.
17. Locate all utilities prior to starting installation.
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