HomeMy WebLinkAboutSWG2022-00002 - SWG Application / Design - 1/6/2022 (2) MASON COUNTY "'N6T"STREET,S"E7-967 ,EXT 400
SHSTREE STREET,
ON,WA EXT 400
BELFAIR:360-275-4467.EXT 400
Public Health & Human Services ALMA:360-482-5269,EXT 400
FAX.360-427-7787
On-Site Sewage System Permit: SWG2022-00002
APPLICANT GLENN PETERSEN Phone: 1.360.275.8831
Address: PO BOX 2883 BELFAIR, WA 98528
OWNER GLENN PETERSEN Phone: 1.360.275.8831
Address: PO BOX 2883 BELFAIR, WA 98528
SEPTIC DESIGNER Jim Zimny-Advantage Perc& Design Phone: 360-516-7287
Address: 7178 WINDFLOWER PL NW SEABECK,WA 98380
Site Address: 181 E Hillside Dr
Primary Parcel Number: 222215300080
Permit Description: 2-bedroom gravity system: Revised
Permit Submitted Date: 01/06/2022
Permit Issued Date: 02/28/2022
Issued By: David Anderson
Current Permit Fees Paid: $1,075.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 01/07/2025 (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 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/environmentallonsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
1- RB • 6 V f OFFICIAL USE ONLY
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION z m
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PHONE
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MAILING ADDRESS-STREET.GUY.STATE,ZIP err 3 3
PO Box 2883, Belfair WA 98528 D
SITESTREET.CITY.
OP CODE C ..
181FHillsided`Belfair wa 98528 .tI N
NJ 360-516-7287 N I N
PHONE
Jimim Zimny ,mil
NAME OF INSTALLER PHONE CIITV
PERMIT TYPE(select one)
DRINKING WATER SOURCE N IN IK RESIDENTIAL OSS F COMMUNITY OSS FCOMAERCIALOSS Fa C
PRIVATE INDIVIDUAL WELL 6 PRIVATE TWO-PARTY WELL 2 I_
TYPE OF MURK Gate one) P. PUBLIC WATER SYSTEM Iia T
6W NEW CONSTRUCTION I UPGRADES REPAIR I REPLACEMENT OTHDi DETAILS(seta al el apply) O TABLE IX REPAIR I(�
SUBMITTALS ❑ CI ED
SURFACING SEwLGE EXISTING FAILURE O SHOREUNE Olt
Id DESIGN FORM(REQUIRED) FSEPIIC DESIGN(REQUIRED) DECROOMS 2 LOT SIZE 23Acres Q R.
6 WAIVER(S)OFAPPUCABLE) <7 L
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DIRECTIONS TO SITE AND SETECONDRIONS(a Mlal pale)
From Hwy 106, turn uphill on E Creekside Dr, in 40'take left on E Twonoh falls Dr. I I C
In . 4 miles are left onE Hillside Dr. Lot is marked with address on left in .2 miles. pink o I
ribbons to test holes. -111 ItO
SUEMUSTS�GGED FFROMAWNROAD �MUST DNRN TEST HOLE MIRBERS tigle I
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE Ilw,eptinp purymss)
O VOLUNTARY O MAINTENANCEIPUM%NG O BUILDING PERMIT OHOME SALE OCOMPIAINT 0OTHER:
INSPECTOR SOIL LOGS COMMENTS I CONDITIONS
Tit 1: 0- S06, t5 to boliRIof hot( yoG 4�
THa: v- Y ' 67l S to br+foN, of h4tt 4 <,>
{kicl(rif OF Con0a0 or1 id+Wf �o
T 43: 0- 5014L. Pied 5 le balrm ri hole
RECORDMAVANG AND INSTALLATION REPORT
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EMREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSPECTO SIGNATURE DATE APPLICATION EXPIRATION DATE ANTIC PPROVECVISSU )BY DATE
rr 1//ZI/ u? ? I/7/102S � 1/4/ 6473
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSNB REVISED 1 /2015
•
DESIGN FORM-PAGE ONE Assessor's Parcel Number. 22215300080- -
A design will be reviewed when 3 cooks of each of the following are submitted:
Completed design form that has been signed and dated. 0 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 far public view an the Masan County Web site.Maximum paper size: I l"X 17"
PARCEL IDENTIFICATION
Permit Number. SWG 2 72_-00(162- Designer's Name: Jim Zamny
Glenn Peterson 360516-7287
Applicant's Name: Designer's Phone Number:
PO Box 2883 7178 wiMflower pl nw
Mailing Address: Bair WA9852s Designer's Address:
Seabed( . .. WA Mt
CLEAR FORM
City State Zip City Stale Zip
DESIGN PARAMETERS
Treatment Device
❑Glendon Biofilter ❑ Sand Filter 0 Mound 0 Sand Lined Drainfield ❑Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
tWGravity 0 Pressure El Trench ❑Bed ❑Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class 3034
Daily Flow: Operating Capacity 180 gpd Length 45 ft
Daily Flow: Design Flow 240 gpd Diameter 4 in
Septic Tank Capacity(working) 1200 gal Number 3
Receiving Soil Type(1-6) 4 Separation 5' CTC ft
Receiving Soil Appl. Rate 0.6 gpd/ft' Orifices
Required Primary Area 400 ft Total Number of a; ",, s
Designed Primary Area 400 ft Diameter .1,/ itt in
Designed Reserve Area 300 ftr 1.
Spacing a(� .'t in
Trench/Bed Width 3 ft °�" iIJa..� ";'Manifold
Trench/Bed Length 135 ft Schedd'"l�er. Doesioier
Elevation Measurements Length Emil'2--TS ft
Original Drainfield Area Slope 4 % Diameter in
New Slope.If Altered 4 / Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slope 14 in Transport Pipe
from Original Grade tbwrvekmpe 12 in Schedule/Class 3034
Designed Vertical Separation 36 in Length 25 ft
Gravelless Chambers Required? ❑Yes 0 No IF(Opdonal Diameter 4 in
Pump Required? ❑Yes ErNo Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day
Dill'. in Elevation Between Pump&Uppermost Orifice ft Dose quantity gal
Drainfield Squirt Height/Selected Residual(head) ft Chanter Capacity(flood) gal
Uppermost Orifice 0 Higher °Lower than Pump Shutoff
Pump controls:Please check those required.
Capacity v Total Pressure Head gpm °Tinter °Elapse Meter 0 Event Counter
Calculated Total Pressure Head ft If Timer Pumpn .. - .Pomp off
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number 22215300080 — —
, Permit Number. SWO
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
El Test hole locations Id Drainfield orientation and layout Reference depth from original grade:
t Soil logs g Trench/bed dimensions and Er Septic tank
e i Property lines critical distances within layout B Drainfield cover
m Existing and proposed wells V D-Box/Valve box locations Reference depth from original grade
within 100 ft of property El. Septic tank/pump chamber and restrictive strata:
® Measurements to cuts,banks,and locations IB Laterals,trench/bed,top and
surface water and critical areas H Observation port location bottom
H Location and onentation of H Clean-out location 0 Curtain drain collector
curtain drain and all absorption ❑ Manifold placement 0 Sand augmentation
components ❑ Orifice placement Other cross-section detail:
Ig Location and dimension of g Lateral placement with distance ar Observation ports/clean-outs
primary system and reserve area to edge of bed
El Buildings g Other Information
❑ Audible/visual alamr referenced Yes No
El Direction of slope indicator g Scale of drawing shown on scale ❑ ef Design staked out
0 Waterlines bar 0 0 Recorded Notices attached
✓ Roads,easements,driveways, hr ❑ ❑Wave (s)attached
parking rrr 0 in Pump curve attached
r 0 ❑Evaluation of failure
El North arrow and scale drawing /;I rya
shown on scale bar 3 '9 rr Non-residential justification
I7� �"([r 'dry ❑ ❑Waste strength
- ', •I•DESIGNER rr ❑ ❑Flow
DESIGN Arh'ROYAL
The undersigned designer must be notifi b ins rat time of installation g(Yes 0 No
Signa Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health and determineditto be in
compliance with state and local on-site re ations:
Environmental Health Specialist Date. )
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION: .
✓ The design is stamped"Approved"by Mason County Public Health. •
/ �l Z0��
✓ The Onsitc 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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Advantage Perc & Design
Construction Notes for Gravity 2 Bedroom System:
Equal Distribution w/graveless chambers(Rock and pipe may be substituted)
Install 3-45' Laterals w/4 hole d-box.
Install on 5'foot centers. - -
Install 12"deep on low side of trench maintain 36"of vertical separation
Install level and along contours.
Install in dry weather only.
Use 1200-Gallon septic
System designed for typical residential waste strength sewage only.
System designed for 240 Gallons Per Day y
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