HomeMy WebLinkAboutSWG2023-00486 - SWG Application / Design - 11/14/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
(AI":
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: SWG2023-00486
APPLICANT ESTEBAN ET UX ANTONIO GERVACIO Phone: 1.360.401.9855
Address: PO Box 3340 SHELTON, WA 98584
OWNER ESTEBAN ET UX ANTONIO GERVACIO Phone: 1.360.401.9855
Address: PO Box 3340 SHELTON, WA 98584
SEPTIC DESIGNER Cindy Waite Phone: 360-701-0205
Address: 80 E Pickering Lane SHELTON, WA 98584
Site Address: 473 E Capital Prairie Rd
Primary Parcel Number: 320084290160
Permit Description: 3-bedroom gravity system
Permit Submitted Date: 11/14/2023
Permit Issued Date: 12/06/2023
Issued By: David Anderson
Current Permit Fees Paid: $780.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 11/16/2026 (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 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
DATE RECEVED.
,;'. ' '. , MASON COUNTY ) , ( 14 I 2-0 2--3 u) I.
y s.,I. F- COMMUNITY SERVICES AMO ,REGTS0 RECEIVED Y W
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'fir Public Health(Community Health/Environmental Health) C N
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415 N.6th Street-SheRort WA 98584 S V\/G �']--e J�� - 0 } a O Po
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ON—SITE SEWAGE SYSTEM APPLICATION v70
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PHONE
APPLICANT m m
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ANTON IO ESTEBAN 360-401-9855 z
MAILING ADDRESS-STREET,CITY.STATE,ZIP CODE g
PO BOX 3340 SHELTON WA 98584 03
4 CODESITE ADDRESS-STREET CITY ZIP 73 E CAPAITAL PRAIRIE RD SHELTON WA 98584 ' co
NAME OF DESIGNER PHONE N
CINDY WAITE 360-701-0205
NAME OF INSTALLER PHONE 0 I CI
TBD ( o
PERMIT TYPE(select one) DRINKING WATER SOURCE O
(f RESIDENTIAL OSS 11 COMMUNITY OSS fl COMMERCIAL OSS h PRIVATE INDIVIDUAL WELL M PRIVATE TWO-PARTY WELL Z I we."
TYPE OF WORK(select one) CI PUBLIC WATER SYSTEM t
W NEW CONSTRUCTION/UPGRADES n REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I -
SUBMITTALS
❑ SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
W N
I DESIGN FORM(REQUIRED) I SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE
°
WAIVER(S)(IF APPLICABLE) 3 166 'X425 ' I t
CD
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex locked gate)
GO EAST ON JOHNS PRAIRIE ROAD, TURN RIGHT ONTO PRODUCTION/CAPITAL I o
HILL RD, TURN RIGHT ONTO CAPITAL PRAIRIE RD, PARCEL IS ON THE RIGHT SIDE, o I
SOIL LOGS ON THE FRONT OF PROPERTY. —I
I0.3
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I 0
OFFICIAL USE ONLY BELOW THIS LINE - ---
UPGRADE/FAILURE SOURCE(tor reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ['COMPLAINT 0 OTHER.
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
H.Z : O— 32` L41645
14l: 0-?1 ` LAMS
32-L `i9 Med$ '7ecf 60 y9 w/ Sit.41 %vakei
4.
T 3: 0-3Js t weds
p 33- 49' V6711L°d$
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.
INSPE TOR SIGNATURE DATE APPLICATION EXPIRATION OATS APPLICATION APPROVED/ISSUED BY DATE
11J /6/ 7073 1I 116/ ? 7r . l 2 /‘/Ze23
THIS FORM'MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBS!TE REVISED'2I7/.Y1`..
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DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 0 0 8 4 2 — 9 0 1 6 0
A design will be reviewed when 3 copies of each of the following are submitted:
Completed design form that has been signed and dated. '1 Scaled layout sketch, including all appl cable items on checklist
Scaled plot plan,including all applicable items on checklist. Cross-section sketch, including all appl cable items on checklist.
This form may be scanned and available for public view on the Mason County Web site.Maximum paper size: //"X 17"
p PARCEL IDENTIFICATION
Permit Number: SWG On -00 -1 u bd Designer's Name: CINDY WAITE
A licant's Name: ANTHONY ESTEBAN 360-701-0205
Pp Designer's Phone Number:
MailingAddress: PO BOX 3344 1 80 E PICKERING LANE
Designer's Address: _
SHELTON WA 98584 SHELTON 98584
City I State Zip City State
DESIGN PARAMETERS '
Treatment Device 4?42
o Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainlield 0 Recirculating Filter.Ty)e: RFC `�
❑ Aerobic Unit Make/Model El Disinfection Unit Make/Model Other: E/1/�D
Drainfield Type
Er Gravity 0 Pressure RrTrench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications 1 Laterals
Number of Bedrooms 3 / Schedule/Class ASTN12729 ..--
Daily Flow:Operating Capacity 270 gpd Length 50 fy
Daily Flow: Design Flow 360 gpd Diameter 4
ill
Septic Tank Capacity(working) 1500 r gal Number 3
Receiving Soil Type(1-6) 3 Separation 9 ft
Receiving Soil Appl. Rate .8 ' gpd/�1;1 - O I. rifices
Required Primary Area 450 frt-J 1,� 'Total Number of Orifices ASTM PERF
airDesigned Primary Area 450 - - elf iameter ill
~ T
Designed Reserve Area 450 o rgoFxtns ' I:king ' ill
Trench/Bed Width 3 4:iP1}s . r I Manifol
Trench/Bed Length 150 J y` t 5t004.8 t:f:�•/Cla`s4,"" D BOX C
Elevation Measurements— LIC NS Y E, d , �,'' 1 ft
Original Drainfield Area Slope <( �..•��..<•►• ....1 •. �.-- -,�/
P,01 I. 0510/ Ill
New Slope, If Altered % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slopc 12 'in Transport Pipe
from Original Grade Down-slope 12
yin Schedule/Clads 034 �
IDesigned Vertical Separation 36 in Length ft
Gravelless Chambers Required? 0 Yes 0 No 0 Optional Diameter ; 4 in
Pump Required? 0 Yes RI 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
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls: Please check those requi ed.
Capacity @ Total Pressure Head gpm ❑'Tinley ❑Elapse Met r 0 Event Counter
Calculated Total Pressure Head ft /� PPROVF� , Pulnp off
Comments \\6/
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DEC 0 6 2023
MASON COUNTY ENVIRONMENTAL I IEALTH
DJA
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DESIGN FORM—PAGE TWO Assessor's Parcel N4ber: 3 2 0 0 8 -- 4 2 -- 9 0 1 6. 0
Permit Number: SWO_
I
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Sec l'on Sketch
Ei Test hole locations 121 Drainfield orientation aid layout Reference depth from original grade:
0 Soil logs g Trench/bed dimensions and g Sep is tank
Q9 Property lines critical distances within 'ayout [i71 Dra nfield cover
g Existing and proposed wells g D-Box/Valve box locations Reference depth from original grade
within 100 ft of property g Septic tank/pump chamber and restricti e strata:
Ifilhh'Measurements to cuts, banks,and locations Li4 Lat als,trench/bed, top and
ilk``surface water and critical areas gObservation port location botti nl
�'l.,ocation and orientation of 12( Clean-out location 0 Curt:in drain collector
curtain drain and all absorption manifold placement 0 San. augmentation
components
b'rifice placement Other cross-section detail:
Ig Location and dimension of
g primary system and reserve area g Lateral placement with distance Observation ports/clean-outs
iZiBuildings to edge of bed Other Infoimation
4 .Audible/visual alarm ref renced Yes No
El Direction of slope indicator Scale of drawing shown n scale
g Waterlines Q d 0 Design staked out
bar I 0 0 Reco-ded Notices attached
g Roads,easements, driveways, I ❑ 0 Waiver(s)attached
,parking 0 0 Pump curve attached
E North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ 0 Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be notif-ie y insta er at time of installation EYes 0 No
44 _ < < 13a1 za3
Signature Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health and deters ill
compliance with state and local on-site gu lions: i IT°
lits
l Z/00 Z3 1 DEC 0
Environmental Health Specialist Date if AS�NcOUNryENV 6?023
✓CAUTION:The desigt'DESIGN is "Approved" IS VALID ONLY n County PUNDER THE lic FOLLOWING CONDITION JA NMFNTgt Hr.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration ate is: I J ?a7 t
✓ Drainfield site conditions have not been altered to adversely affect konditions of design ap. oval.
Please Note: The system must be installed by a certified it staller,
unless prior authorization is obtained from Mason County Public Health.
An Installation Fee is required.
i4Ag
This form may be scanned and available for public view on the Mason County Web s te.
Updated Date: 12/7/201
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DEC 0 6 2023
MASON COUNTY ENVIRONMENTAL HEAL?
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17 j Speed Levelers(or equal)required
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APPROVED
DEC 0 6 2023
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MASON COUNTY ENVIRONMENTAL HEALTH y�P � 41 0 , U2
DJA e CINDY Eco WAITE i13
LICENSED DESIGNER
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Installation Notes
Gravity Distribution System:
473 E Capital Prairie Rd 32b08-42-90160
3. System to be installed by a licensed Mason County installer. Self in ll must
follow Mason County Healty Departments requirements.
4. Install system during dry weather with acceptable spit conditions
5. Keep wheeled vehicles off the drainfield area before, during and after installation.
Tracked equipment only,
6. All ground, surface water and roof drains must be diverted away from the septic tanks
and drainfield. Ensure the final grade slopes away from these areas and water doesn't
collect on or around them. Use swales, berms, catch basin and tight lines, curtain drains,
etc. to divert all waters.
7. Curtain drains can be no closer than 10' upgradient and 30' down gradient of the
drainfield
8. Exposed restrictive layers. cuts, banks, etc. can be no closer than 50' do1nhill from the
drainfield. II
9. Install access risers on the septic tank, D-box and observation ports.
10. Make sure septic tank risers are epoxied or caulked to cast in riser rings on tank.
11. Lids must form a water and gas tight seal with the access risers •
12. Install effluent filter at the septic tank outlet.
13. This system must be installed by a Mason County Certified Installer.
14. Deviation from this design without prior approval from the designer and M son County
Health Department will make this design null and void.
15. This design was sized per Washington Administrative CodeWAC246-272A-0230. The
operating capacity is based on 45 gallons per day per capita with two persons per
bedroom. The minimum design flow per bedroom per day is the operating Capacity of
ninety gallons multiplied by 1.33. This results in a minimum design flow of One hundred
twenty gallons per day. This creates a surge factor of 33% but anticipated flow is ninety
gallons per bedroom per day.
16. Install laterals or bed with contour of the ground
17. Install trench bottoms level and always maintain a minimum of six inches into native soil
the drench wal
APPROVED e„ .p�
4� OF tosti
DEC 0 6 2023
MASON COUNTY ENVIRONMENTAL HEALTF or'). IN sto at irE �� OVI°
DJA LIC ED DESIGNER
ExwRES 05't0,
System Owner Responsibilities:
1. Operation and Maintenance is required by Washington State Departmen, of Health and
Mason County Health Department.
2. The septic tank should be pumped every three to five years or as needed.
3. System owners are responsible for having maintenance performed every three years as
per WAC246-272A.
4. System owners are responsible for responding to septic issues in a timely manner.
5. System owner agrees to read and abide by information regarding their system in the
User Manual provided by Mason County Public Health.
6. Keep the flow of sewage at or below the approved design operating capacity.
7. Keep waste strength at residential waste strength parameters.
8. Spread loads of laundry through the week.
9. Do not use excessive bleach or detergents with added whiteners.
10. Do not shower, do laundry and dishwasher at the same time
11. Antibiotics can kill or impair the biological process in the septic tank.
12. Leaky plumbing can hydraulic overload your on-site septic system.
APPROVED
DEC 0 6 2023
MASON COUNTY ENVIRONMENTAL HEALTH
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