HomeMy WebLinkAboutSWG2023-00510 - SWG Application / Design - 12/4/2023 MASON COUNTY 415 N 6TH STREET,SHELT 98584
SHELTON:360 427-9679670,EXT 400 400
r 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: SWG2023-00510
APPLICANT VINCENT HARTNEY Phone: 541-380-1965
Address: 15632 92nd Way SE YELM, WA 98597
OWNER VINCENT HARTNEY Phone: 541-380-1965
Address: 15632 92nd Way SE YELM, WA 98597
SEPTIC DESIGNER CHRIS ELSTROTT-Advanced Phone: 360-561-5000
Engineering
Address: 128 NORTH RIVER STREET MONTESANO, WA 98563
Site Address: 501 E Eagle Point Dr
Primary Parcel Number: 421227690071
Permit Description: 3-bedroom pressure system w/sand lined bed
Permit Submitted Date: 12/04/2023
Permit Issued Date: 12/18/2023
Issued By: David Anderson
Current Permit Fees Paid: $780.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 12/05/2026 (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 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/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
_ DATE RECHVTD:
.Xr MASON COUNTY i 2 9 / ,)_,3 cn
I , COMMUNITY SERVICES AMOUNT CENED: RECENEDBY pc
1 R � W
-8 J — v_ m
Public Health(Community Health/Environmental Health) C
\ 360-427-9670,ext.400 a 360-275-4467,ex 400 O
-- 415N.6th5treet Shelton,WA 98584 SWG 2023 — OD S 1j ° 73 z
ON-SITE SEWAGE SYSTEM APPLICATION 3 xi
m C)
APPLICANT PHONE m
Vince Hartney 541-380-1965 z
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE ( )
15632 92nd way SE; Yelm, WA 98597
SITE ADDRESS-STREET,CITY,ZIP CODE 4t
N
501 E Eagle Point Drive; Shelton, WA 98584 rn I
NAME OF DESIGNER PHONE I N
Chris Elstrott 360-561-5000
NAME OF INSTALLER PHONE I
Unknown `— Iry
PERMIT TYPE(select one) DRINKING WATER SOURCE O
P(RESIDENTIAL OSS n COMMUNITY OSS n COMMERCIAL OSS nx PRIVATE INDIVIDUAL WELL ❑ PRIVATE TWO-PARTY WELL Z I m
TYPE OF WORK(select one) J PUBLIC WATER SYSTEM t
PI NEW CONSTRUCTION/UPGRADES 0 REPAIR/REPLACEMENT OTHER DETAILS(seeect a6 that apply) ❑ TABLE IX REPAIR I . 1
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE
ta L DESIGN FORM(REQUIRED) WI SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r- 10)
❑ WAIVER(S)(IF APPLICABLE) 3 1.22 acres 0 I .
co
DIRECTIONS TO SITE AND SITE CONDITIONS'(ex locked gate)
501 E Eagle Point Drive; See Vicinity Map On Design. I o
o Io
Iv
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS.
UPGRADE I FAILURE SOURCE Or reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
TIf1: 0- I? t
6ti"-6o EcCGou S iv bow
Tfi- p-il" VALntedr/
zZ -60' E6 tact F
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.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATI OVEDI ISSUED BY DATE
Ili Si c3 /Z/05/ 70z6 lz//o9(z _3
rr
THIS FO M MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THItiMASON COUNTY WEBSITE REVISED 12 1.2015
ti
DESIGN FORM-PAGE ONE Assessor's Parcel Number: Y 2 L? Z -- 2.6 -- 20 0 71
A design will be reviewed when 3 copies of each of the following are submitted:
'1 Completed design form that has been signed and dated. '1 Scaled layout sketch,including all applicable items on checklist
Scaled plot plan,including all applicable items on checklist. '1 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 size: II"X 17"
:z -
:< -. ..'-�'ARGEGIDENTIEIC�ITiON•
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Permit Number: SWG C12.'') - OD 510 Designer's Name: G4/.ems ELsreor/-
Applicant's Name: //iris /74rfne LI Designer's Phone Number: 3Ga-- 5-4/- S000
Mailing Address: /5-6 32- 92„d 1.1, -Si Designer's Address: /2 Al 'eivik
t/e./,ri 4//9 fe sn,7 isiov//5 •✓o, wit fdre3
Cify State Zip City . State Zip
`Y "e` ate`• y,;-t -K, O„,,` s.. +'t c-e� $i.7 5 Fi ,Z;. YJ. 9 { c;'" D PCs xN: �'n;r a'`3 F+',��'rl -_%tib,#"r:
`� .�.�`�����-�k� z s , ��,�.,.> ., '�.�_, , ,�.� � �E�IGN�'ABAMETERS R .t.,�.� .... . ..� r,.�`•..��.• _.�e. _ ..,.
Treatment Device
❑ Glendon Biofilter 0 Sand Filter 0 Mound and Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
❑Gravity C3 Pressure ❑ Trench lallerl 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class 4/
Daily Flow: Operating Capacity _ "vrre 2.70 gpd Length 3 6 - ft
Daily Flow:Design Flow 360 gpd Diameter //y in
Septic Tank Capacity(working) /2400 ✓gal Number y
Receiving Soil Type(1-6) / Separation 2. f ft
Receiving Soil Appl.Rate /.O r gpd/ft2 Orifices
Required Primary Area ..U0 -- ft2 Total Number of Orifices 60
Designed Primary Area 3G p - ftZ Diameter 3//6 in
Designed Reserve Area 3 'a - ft2 Spacing se; in
Trench/Bed Width /0 ft Manifold
' Trench/Bed Length 34 ft Schedule/Class Va
Elevation Measurements Length 7. c ft
Original Drainfield Area Slope • Z % Diameter -2- in
New Slope,If Altered 2- % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slope 2/ in Transport Pipe
from Original Grade Down-slope /9 — in Schedule/Class 4/v -
Designed Vertical Separation 2I/ 1- v in Length 2,0 ft
Gravelless Chambers Required? 0 Yes Cho❑ Optional Diameter 2_ in
Pump Required? l 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 5/
Diff.in Elevation Between Pump&Uppermost Orifice " ft Dose quantity 90 gal
Drainfield Squirt Height/Selected Residual(head) f ft Chamber Capacity(flood) /ZGO ,gal
Uppermost Orifice 0 Hhtigher 0 Lower than Pump Seu off r~9 Pump controls:Please check those required.
Capacity @ Total Pressure Head ,52 gpm 139<ner ❑lie Meter went Counter
Calculated Total Pressure Head _ /2.•2— - itA f 'm : Pum on ,2 4ti sr,Pump off
Comments D /*'/ /4/so Aec/744,
DEC 18 2023
MASON COUNTY ENVIRONMENTAL HEALTH
f1.14
DESIGN FORM-PAGE TWO Assessor's Parcel Number: '/z / 2- 2- -- 7 6 -- 9_ o d Z /
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
hole locations �13-'61 infield orientation and layout Reference depth from original grade:
Coil logs C�Trench/bed dimensions and gtic tank
❑��perty lines critical distances within layout �rainfield cover
D—sting and proposed wells Or D-Box/Valve� box locations Reference depth from original grade
within 100 ft of property D Septic tank/pump chamber and restrictive� �
strata:
Measurements to cuts,banks, and � locations C9-Laterals,trench/bed,top and
su ce water and critical areas C�O ,:nervation port location bottom
L�YLocation and orientation of C��CIe n-out location ,,, C rtain drain collector
c� D and all absorption i ifold placement is Sand augmentation
components f ce placement Other cross-section detail:
cation and dimension of ID--Lateral placement with distance 0 Observation ports/clean-outs
pri ary system and reserve area toe e of bed
u
Other Information
ings udi a/visual alarm referenced Yes N��o��
Direction of slope indicator ❑ cale of drawing shown on scale 0 [ Design staked out
❑ aterlines bar 0 l3orded Notices attached
D oads, easements,driveways, . 0 aiver(s)attached
parking I�❑� �PumP curve attached
Q-1 rth arrow and scale drawing 0 "valuation of failure
shown on scale bar N 1 n-resi s ential justification
❑ • 1 aste strength
• • Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer at time of installation C 1,'Ks ❑ No
//-30-z-3
Signature of Designer Date
'�pp
The undersigned has reviewed this design on behalf of Mason County Public Health and deter nie t •
compliance with state and local on-site lations: ®
ef //qf7 6 73 MAspy��,,�,DEc 8 2023
Environmental Health Specialist Date'pT)ENV/RO
UJA At
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:fYlVeAir
Hfgi-TH
✓ The design is stamped"Approved"by Mason County Public Health. z�OS��OZCJ
✓ 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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