HomeMy WebLinkAboutSWG2023-00459 - SWG Application / Design - 10/23/2023 MASON COUNTY 416 N6THELTON: SHELT96 ,EXT 400
9H STREE ,SHEL-9670,EXT400
4 BELFAIR:360-275-4467.EXT 400
r Public Health & Human Services ELMA:360 482-5269.EXT
X 400
7
On-Site Sewage System Permit: SWG2023-00459
APPLICANT CEDARLAND FOREST RESOURCES Phone: 1.253.225.2942
Address: PO BOX 2269 GIG HARBOR, WA 98335
OWNER CEDARLAND FOREST RESOURCES Phone: 1.253.225.2942
LLC
Address: PO BOX 2269 GIG HARBOR, WA 98335
SEPTIC DESIGNER BRAD SMITH-septic designer Phone: 253-851-2178
Address: PO BOX 1444 GIG HARBOR,WA 98335
Site Address: XXX SE Mill Creek Rd
Primary Parcel Number: 320294450020
Permit Description: 3-bedroom gravity system: Renewal
Permit Submitted Date: 10/23/2023
Permit Issued Date: 11/13/2023
Issued By: David Anderson
Current Permit Fees Paid'. $525.00 (additbnal fees may be required upon Instaua)mn of system))
Permit Expiration Date: 10/23/2026 (based on date of inspection)
Permit Conditions:
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 PUBLIC HEALTH DAAEREC O: I 0 /09-3
ONSITE SEWAGE SYSTEM APPLICATION AMOUNT RECENED BM
8) Shelton WA, 0 m.
ShN[Dre36G477-%70 eXT 900 &NaiL360-175d467 ert400 SWG 2.` �1 -
�59 92 A 7
APPLICANT ( . ` ` PRONE
SWG
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MABJNGANIGF9S-STREET,PTV.STATE 2D CODE 111
it
SITE ADDRESS-STREET,Crz ZIP.900E
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WBE �E.8RBSA PMOIIE ��
/ ;rAl1 .,�' A 1'1l a\ );TT L:t I /: -. P�s
NAME Of INSTALLER PHONE I N
CHECK
�ALL'9FAJGBLE TINS DRINKING WATER SOURGE .i nEildLS V i G I0
FS NEW CONSTRUCTION ❑ RV HOLDING TANK ONLY 0 PRIVATE INDIVIDUAL WELL i
O REPLACEMENT SYSTEM 0 INSTALLATION PERMIT ONLY �❑ PRNATE TWG-F RTY WELL 9
❑ TABLE 9 REPAIR ❑ SINGLE FAMILY L6.OMMUNITY/PU/3HG WATER SYSTEM Z I'"
❑ TANK(S)ONLY ❑ COMMERCIAL SYSTEM NAME:
a UPGRADE TO EXISTING 0 OTHER: BEDROOMS LOT SITE -a.m.-
I�
❑ EXISTING FAILURE "Record OnwMR required
Nr SIMehlplMf' 3 r
DIRECTIONS TO SITE BE SPECIFIC AND ADVISE OF ANY NEEDED INFORMATION FOR ACCESS(m larked pas) 0
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BY:
BNi MUST BE M0060 FROM AWN ROA0AND TOT HOLES NEST SE Pa MTH TEST HOLE MWBENS IU
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/ENURE SOURCE(for repots somas/
O VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ['OTHER'.
INSPECTOR SOIL LOOS COMMENTS I CONCIDONS
TN 5: 0-S5 S FSp, ( ved ()7 i(Ter4it c2 an 1013)1 y -fu- permrl
51-167019-003r0 vndr price4 number
ilty;0-58 F 3zol?-41-00eS0
Ma noslc
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wo sir
W6 CODES:
VvVERY Gv GRAVELLY Sa LaLOAM 91a9LLT C=CLAY E=G1R[MELY Rv ROOT3
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED BY GATE
00300 10/23 /eoz6 i1l/13/10;3
THIS FORM MAY BE SCANNED AND AVAILABLE kOR PUBLIC VIEW ON THE MASON COUNTY WEBSOE REVISED IZOI TE
.
DESIGN FORM-PAGE ONE Assessor's 3Sarcel Number: 3 2CJ 2- '
A design will be reviewed when 3 conies of each of the following are submitted:
v Completed design form that has been signed and dated. r Scaled Layout sketch,including all applicable items on checklist
Scaled plot plan,including all applicable items on checklist. a 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 s size: 11"X I7"
PARCEL IDENTIFICATION
Permit Number: SWG ZnQ1 JJ-0 0 4 Sy Designer's Name: �pt7 N w!
p
Applicant's Name 1 eit: 8 1 Trr 47T Designer's Phone Number; e51-7-°110
Mailing Address: O 2- Designer's Address: �SZ,ZC 1dirdi'49
4' e 'HaAr'cu-rtjjp &Ktr h`brkk$,Y,',. t ' 353
City State Zip City' State Zip
DESIGN PARAMETERS
Treatment Device
O Glendon Biofiltet ❑Sand Fiiter 0 Mound 0 Sand Lined Drainfield ❑Recirculating Filter,Type'.
❑ Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
Gravity ❑Pressure 0 Trench 0 Bed ❑Sub Surface Drip
Septic Tank/Drainfield Specifications Lateralsn
Number of Bedrooms 3 tt
Schedule/Class {mic !s • , ..i
Daily Flow: Operating Capacity .5(esQ Z7(J gpd Length f r) ft
Daily Flow:Design Flow ✓' ( LI gpd Diameter ""r"' in
Septic Tank Capacity y �50 gal Number
Receiving Soil Type(1-6) -/ Separation ft
Receiving Soil Appl.Rate a (00 gpolfi= Orifices ` \
Required Primary Area (007/7 flz/ Total Number of Orifices I V`/1
Designed Primary Area ( cO
, . ftz' ^
Diameter ///_
Designed Reserve Area ( .10 ;'�3in
ftz Spacing ,"' in
Trench/Bed Width J ft '
Manifold
Trench/Bed Length SA() ft Schedule/Class ( VO
Elevation Measurements Lengthft
Original Drainfield Area Slope 1 rs f r e/ Diameter , in
New Slope,If Altered _. ... aj Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slope r 2, in
Transport Pipe
from Original Grade Doxnslope t in Schedule/Class
Designed Vertical Separation ,' ) �in in Length 22 ft
8'Optl
Gravelless Chambers Required? 0 Yes 0 No lonal Diameter q" in
Pump Required? ❑Yes O No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
Difference in Elevation Between Pump SntltofTa$Uppermost Dose quantity gal
Orifice ' R Chamber Capacity gal
Uppermost Orifice 0 Higher 0 Lower than Shutoff Pump controls:Please check those req
Capacity @ Total Pressure Head B�p"m� OThner OElapse M 0 Event Counter
Calculated Total Pressure Head .1 7k P pi i e n * .°; ,Pump off
Comments
NOV 1 3 2023
N3SnF:^mil-i r H , . ,._r I r AlD Id ,.: p v
DESIGN FORM-PAGE TWO Assessor's Parcel Number:.;' s%<-n - 44 -. 5': ^ 2'+ a r'
Permit Number: SWG
- ----
DEslas CHECKLIST$"
Scajed Plot Plan Scajed Layout Sketch Cross-Section Sketch
OcTest hole locations �E grainfield orientation and layout Reference depth from original grade:
/Soil logs L7 Trenchilled dimensions and eptic tank
CJ' operty lines Juitical distances within layout Drainfield cover
Or Existing and proposed wells Z Box/Valve box locations Reference depth from original grade
�/�thin 100 ft of property Septic tank/pump chamber and restri ve strata:
❑" Measurements to cuts,banks, and Jlocations Rf Laterals,trench bed,top and
)urface water and critical areas C' �1lbservation port location bottom
I taxation and orientation of cr Clean-out location ❑ Curtain drain collector
curtain drain and all absorption ❑ Manifold placement 0 Sand augmentation
>�,components 0 Orifice placement OthersJBss-section detail:
Location and dimension of ❑ Lateral placement with distance e' Observation ports/clean-outs
miry system and reserve area to edge of bed
uildings Other Information
/' ❑� A�rdible/visual alarm referenced Yes No
® Direction of slope indicator 2
/Scale of drawing shown on scale 0 C.-Dr-sign staked out
I.Waterlines bar 0 @'Recorded Notices attached
Roads, easements,driveways, 0 Elf-Waiver(s)attached
parking ❑ 0 Pump curve attached
Q''North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑Waste strength
❑ ❑Flow
DESIGN APPROVAL _
The undersigned designer must be notifiedby-instaflerattime of installation Er es 0 No
k (( , 11d
Siggauuc af?S/igper" Date
ARPThe undersigned has reviewed this design on behalf of Mason County Public Health and AM °;ib , en,U
compliance with state and local on-si gulations: " (a:�_i
Environmental Health Specialist D sr• _
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health, /����/W
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
I 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
PENINSULA SEPTIC DESIGNS
P.O.BOx 1444
GIG HARBOR.WASHINGTON 98335
(253)851-2178
FAX(253)851-2178
Tacoma Pierce County Health Department \O-- 9 - �Z
3629 South "D"Street Date
Tacoma, Washington 98408
RENEWAL LETTER
PR old: 5v( zoIt-oo38o APpRotp
Nem: Stifi z013•ooycQ. NOV / 3 -
RE: fOL — 44-- 5O67' 023
q ;.1,
To Whom. It May Concern,
This letter is written to inform you that we have inspected the above mentioned site on
c{- 0-poi and found that the site conditions have not been disturbed. After
reviewing the design that was approved on q-Z'8' 1-o1°l it is our opinion
that the site meets current is M County Health Department Standards for the attached
renewal design.
Thank you for your attention in this matter.
Sincerely,
Sandra R. Smith
Certified Designer
/ / /
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