HomeMy WebLinkAboutSWG2023-00439 - SWG Application / Design - 10/27/2023 MASON COUNTY 415 N6THELTON: ,SHELT96 ,EXT 400
SBELTON: ,SHEL-967q EXT400
BELFAIR'360-275-4467,EXT 400
Public Health & Human Services FLMA 360-482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00439
APPLICANT WATERBURY KEVIN EARL &JESSICA Phone:
NAOMI
Address: 2502 PERRY AVE BREMERTON, WA 98310
OWNER WATERBURY KEVIN EARL &JESSICA Phone:
NAOMI
Address: 2502 PERRY AVE BREMERTON, WA 98310
SEPTIC DESIGNER Jim Zimny -Advantage Pere& Design Phone: 360-516-7287
Address: 7178 WINDFLOWER PL NW SEABECK, WA 98380
Site Address: XXXX NE Tahuya Blacksmith Rd
Primary Parcel Number: 223177590061
Permit Description: 3-bedroom gravity system
Permit Submitted Date: 10/17/2023
Permit Issued Date: 11/29/2023
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 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.Phe or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
DATE'SOWED MASON COUNTY t0 Ix a�3
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION s z
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APPUGANT
PHONE
Kevin Waterbury 702-461-72221lIIIIrr`)jj) 11aB�+1� i
05_M 11�-" JSv3I m
MAILING ADDRESS.STREET CITY.STATE.ZIP COCE
2502 PerryAve, Bremerton WA 98310 m
SITE ADDRESS STREET.CITY.ZIP CODE 1''.^ I 1 / Y. L-. A
NE Tahuya Blacksmith, Tahuya WA 98588 'IN)I
NAME OF DESIGNER PHONE BY:JIM ZIMNY 360-516-7287 I'__v,
NAME OF INSTALLER PONE a IN/_1
PERMIT TYPE ryekc(one) DRINKING WATER W ROE CT)iii RESIDENTIAL OSS h COMMUNITY OSS ii COMMERCIAL OSS ii PRIVATE INDIVIDUAL WELL In PRIVATE WO-PARTY WELL Z Li
TYPE OF WORK(soled one) ❑ PUBLIC WATER SYSTEM
in NEW CONSTRUCTOR/UPGRADES 17 REPAIR/REPLACEMENT OTHER DEIAll S(sdectalwlapgy) 0 TABLE IX REPAIR
SUBMITTALS 0 SURFACING SEWAGE CIEXISTING FAILURE CISHORELINE
03
FM DESIGN FORM(REQUIRED) IN SEPTIC DESIGN(REQUIRED) BEDROOMS 3 LOTSIZE 2.98 ACRES O 1
*WAIVER(S)(IF APPLICABLE) O
DIRECTIONS TO SITE AND SITE CCNGRONS(ex AVMl gale) I—()
From Belfair travel down Northshore Rd 3.2 mi and take rt on Beltair Tahuya RD Io
Go 4 mi and take rt on Haven Way, go 2.4 mi and take rt on Mountain View rd. I— I
In .8 mi take rt on Tahuya Blacksmith RD. In 1.5 miles the lot in on the left marked with pink o p
ribbons. Flow pink ribbons to test holes. I6-•
SITE MUST SE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLANGED WITH TEST MHEWYPERS I
OF FICI AL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE{Tor Tapering purposes)
ID VOLUNTARY ❑MAINTENANCE/PUMPING 0 BUILDING PERMIT OHOME SALE OCCMPLMNT OOTHER:
INSPECTOR SOIL LOGS COMMENTS I CONDITIONS
I (fz(7 32675L
711 1 0 - 3 z' 65L
TN '1
30 _ zrAI (15(
Th5} pit 73 I(;
RECORD DRAWING AND INSTALLATION REPORT
SOIL CODES:
=VERY G=GRAVELLY S=SAND L=LOAM 51=SIR C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL
INSPECTOR SI TORE DATE APPLICATION EYPIRATION DATE ATRIC ION APPROVED ISSUED BY DATE
THIS FORM MAY DE SCANNED 10I I‘N 7076
COUNTY WEISITE I l itr/la�t
' DESIGN FORM-PAGE ONE Assessor's Parcel Number 223177590061- -
A design will be reviewed when d 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 hens on checklist.
ibis form may be scanned and available for public view on the Mason County web site.Maximum paper size: /I n X 17„
I�1, 1 PARCEL IDENTIFICATION
Permit Number: SWG A-(\I lds3' 004 J6\ Designer's Name James Zimny
Kevin Waterbury Designer's Phome Number 360 516-7287
Applicant's Name:
2502 Perry Ave 7178 Wiid lower PI NW
Mailing Address: Designer's Address:
aremertcn WA emu Seebeck WA
CLEAR FORM
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device
❑Glendon Bioflter 0 Sand Filter 0 Mound 0 Sand I.ined Drainfield 0 Recirculating Filler.Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit MakerModel Other:
Drainfield Type
IF/Gravity 0 Pressure Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 3034
Daily Flow:Operating Capacity 270 gpd Length 50 _ ft
't
Daily Flow: Design Flow 360 /gpd Diameters r 4 in
l
Septic Tank Capacity (working) 1200 'gal Numb it,..t 4
Receiving soil Type(1-6) 4 Se...=t ?5' t4 5 etc ft-
Receiving Soil Appl.Rate 0.6 'gpd/ft' 'f�. �ttrrr Orifices
Required Primary Area 600 i ft .. �,, ,,• s N/A
Designed Primary Area 600 ft tier Ima in
Designed Reserve Area 600 ft' Spacing in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 200 ft Schedule/Class N/A
Elevation Measurements Length ft
Original Drainfield Area Slope 6 % Diameter in
New Slope,If Altered 6 % Preferred rmnifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slop: 12 in . Transport Pipe
from Original Grade Downape 10 in Schedule/Class 3034 -
Designed Vertical Separation 18 in - Length 20' ft
Graveness Chambers Required? ❑Yes 0 No Ef Optional Diameter 4 in
Pump Required? ❑Yes El No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
Diff.in Elevation Between Pump&Uppermost Orifice ft Dose quantity gal
Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(flood) gal
Pump controls:Please check those required.
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff
Capacity @,Total Pressure Head gpm OTimer OFdapse Meter 0 Event Counter
Calculated Total Pressure Head ft If Timer -Pump on , .Pump off
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number 223177590061— —
Permit Number. SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
e Test hole locations H Drainfield orientation and layout Reference depth from original grade:
e Soil logs PI Tench/bed dimensions and lg Septic tank
B Property lines critical distances within layout F3 Drainfield cover
ig Existing and proposed wells Er D-Box/Valve box locations Reference depth from original grade
within 100 ft of property Ef Septic tank/pump chamber and restrictive strata:
II Measurements to cuts,banks,and locations Id Laterals,trench/bed,top and
surface water and critical areas B Observation port location bottom
O Location and orientation of Id Clean-out location ❑ Curtain drain collector
curtain drain and all absorption ❑ Manifold placement ❑ Sand augmentation
components ❑ Orifice placement Other cross-section detail:
t Location and dimension of pJ lateral placement with distance a Observation ports/clean-outs
primary system and reserve area to edge of bedEl Other Information
Buildings ❑ Audible/visual alarm referenced Yes No
O Direction of slope indicator e( Srale of drawing shown on scale ❑ eDesign staked out
e Waterlines bar -r ❑ S Recorded Notices attached
El Roads,easements,driveways, , tyr Fl 0 Waiver(s)attached
parking �'!y ❑ ❑ Pump curve attached
El North arrow and scale drawing /§"r"rr, 0 0 Evaluation of failure
shown on scale bar i ft rye Non-residential justification
p u. j rr rr ❑ ❑Waste strength
Flow
QS
DESIGN APPROVAL
The undersigned designer must be notiee er at time of installation ErYes ❑ No
if%f6ate
Si Designer ate
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in
compliance with state and local on-site rations:
1110(Z0n?
Environ pal Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. I Q( `��1aG
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
✓ 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
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Construction Notes for 3 Bedroom Gravity System
Gravity w/graveless chambers(Rock and pipe may be substituted)
Install 4-SO) Laterals. -,
Use a 6 hole d-box and speed levelers % ��,�
Install on 5'foot centers.
1,
Install 12"trench depth on low side of trench and maintain 36"of vertical separation f ,e'
M... 4
Install level and along contours. Insomb• ib ����
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Install in dry weather only. r+w.=a/rn `L�
Use 1200-Gallon septic and add risers for pumping and maintenance
System designed for typical residential waste strength sewage only.
System designed for 360 Gallons Per Day
Advantage Perc&design ® . ® (360) 516.7287
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