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Home My WebLink AboutSWG2024-00047 - SWG Application / Design - 2/8/2024 a MASON COUNTY 415N 6TH STREET,SHELTON,WA 98580 SHELTON:360-027-9670,EXT 400 ,.., i BELFAIR:360-275-4467,EXT 400 . ,. Public Health & Human Services ELMA:36o-482-5269,EXT 400 FAX:360-427-7787 On-Site Sewage System Tank Only Permit: SWG2024-00047 OWNER BARNES ET VIR MELISSA Phone: Address: 2213 SOPHIE WAY NW OLYMPIA, WA 98502 APPLICANT BARNES ET VIR MELISSA Phone: Address: 2213 SOPHIE WAY NW OLYMPIA, WA 98502 SEPTIC INSTALLER JAKE GOLDY' Phone: 360-490-0649 Address: PO BOX 159 MATLOCK, WA 98560 Site Address: 41 N LAKE SURF DR Primary Parcel Number: 323095106066 Permit Description: Replace septic tank Permit Submitted Date: 02/08/2024 Permit Issued Date: Issued By: Rhonda Thompson Current Permit Fees Paid: 5265.00 (additional fees may be required upon installation of system). Permit Expiration Date: 02/08/2027 (based on date of inspection) Type of Work OSS Repair Components being Replaced: Septic Tank Only Surfacing Sewage? No Existing Failure? Yes Shoreline? No Horizontal Setbacks Met? Yes Number of Bedrooms: 1 Drinking Water Source: Public Water System Additional Details: IM-1060 Permit Conditions: 2 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 1 Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained 4 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 3 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/OR 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: 360-027-9670, extension 400. OFFICIAL USE ONLY MASON COUNTY DATE RUINED; 2/ w2 I w n COMMUNITY SERVICES AMOUNT R DOE)CJ RECEIVED BY c y Public Health(Com(Community Health/Environmental Health) L �• O y EH N ph Lai haprop pa .Ia SWG -� �v� $ CO ON-SITE SEWAGE TANK ONLY APPLICATION >• > • 03 APPLICANT' LittJ�-�_' PHONE m r m 'C `7(e-ti% S;1 77c' }'I z MAILING ADDRESS.GYRE CITY.STATE PCODE C 3 Te a• !3 et- i S`i le z SITE ADDRESS-STREET.CITY.ZIP CODE rr� �1C)cIC , /v64- ci')s/(, NAME OF DESIGNER PHONE I F.. NAME OF INSTALLER PHONE v V 'il1(2 elofc]ij DRINKING WATERso4(00 �oo GGLii N I , TYPE OF WORK(mlttYOne) ❑ NEWCONSTRUCTION/UPGRADES g EPAIR/REPLACEMENT ❑ PRIVATE INDIVIDUALWELL 0 PRIVATE TWO-PARTY WELLI Z Imo; COMPONENT(S)TO BE REPLACED/INSTALLED •prl} PUBLIC WATER SYSTEM SEPTIC TANK 0 PUMP TANK ❑RV HOLDING TANK BEDROOMSE 4 LOTS17F I Iyb. O OTHER - o thatthat ` !l/l OTHER DETAILS(select all apply! C_P-`�t4t �H T ANK{ )SETBACK CHECKLIST ) r I ❑ SURFACING SEWAGE Et-EXISTING FAILURE 0 SHORELINE IG t00FT+PUBLIC/COMMUNITY WELLS 0 ' SUBMITTALS —W/FT+PRIVATE WELLS,SURFACE W4TERS.STREAMS.RIVERS O PLOT PLAN(REQUIRED) 0 TANK CROSS SECTION(REQUIRED) OFT+DRINKING WATER SUPPLY LINES I!"' ❑ PUMP DETAILS(IF APPLICABLE) 0 WAIVER(S)(IF APPLICABLE) mie5FT+PROPERTY/EASEMENT LINES.FOUNDATIONS,FOOTINGS PLOT PLANCHECKLIST 'a I - L] PROPERTY LINES AND EASEMENTS @"EXISTING/PROPOSED STRUCTURES EXISTING/PROPOSED OSS COMPONENTS AND LINES ~ G ❑ WELLS WTH IN 100FT 0 WATER SUPPLY LINES DRIVEWAYS/PARKING 0 SURFACE WATERS.STREAMS.RIVERS.ETC IC O DIRECTION OF SLOPE/CONTOURS ❑ PERIMETER/CURTAIN DRAINS pMORTH ARROW 0 SCALE BAR I ,_ DIRECTIONS TO SHE AND SITE CONDITIONS.lee loc.)e0ge(e) �. 1,15114 LIT EC I 1TP C LC1.} y . -A. . I(.,,L, Lc4-F- ti- Fct+c tie=-»ire-—Tr-e. c— 1' ,,k:z.(,.' c..4.cv,....4 E,-w if j Li I LiIF+* SL./.411 Pr. rA-,k. Sha-4 O✓ C-+1 ;• OFFICIAL USE ONLY BELOW THIS LINE UPGRADE I FAILURE BO CE Dor repomng purposes) ❑VOLUNTARY AINTENANCE/PUMPING 0 BUILDING PERMIT OHOME SALE ❑COMPLAINT O OTHER'. COMMENTS/CONDITIO s k (n�ctC� Se i,c_ tt\f VL SEWAGE TANKS MUST BE LISTED UNDER DOH"LIST OF REGISTERED SEWAGE TANKS' TANKS MUST MEET CURRENT MINIMUM SIZE REQUIREMENTS.EQUIPPED KITH RISERS AND LIDS TO SURFACE AND INCLUDE AN EFFLUENT FILTER IIF APPLICABLE) RECORD CRANING AND INSTALLATION REPORT REQUIRED FOR FINAL APPROVAL INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE 21 Cii hC IiIa AI CMI *ILL( THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12r4015 UNFILTRAToR'" APPROVED FF 09 2024 dtASON rnfrfr'"'i;,-- ti4:vrsLi+EALTW �- �E� • Strong injection molded polypropylene _ construction - � t i • Lightweight plastic construction and ((( /Ill ' y' inboard lifting lugs allow for easy delivery and handling it, Ir/,! • Integral heavy-duty green lids that ' I I interconnect with TWT"" risers and pipe Priser solutions BE � y NI w.moor' - Structurally reinforced access ports eliminate distortion during installation and pump-outs •�'' SW ` - Reinforced structural ribbing and fiberglass bulkheads offer additional strength • Can be installed with 6" to 48" of cover The Infiltrator IM-1060 is a lightweight strong and durable septic tank. • Can be pumped dry during This watertight tank design is offered with Infiltrator's line of custom-fit pump-outs risers and heavy-duty lids. Infiltrator injection molded tanks provide a • Suitable for use as a septic tank, pump revolutionary improvement in plastic septic tank design, offering long-term tank,or rainwater(non-potable) tank exceptional strength and watertightness. • No special water filling requirements Inlet Side are necessary • The tank may be backfilled with suitable TANK CUTAWAY Infiltrator - native soil. See installation instructions - TW Riser (4 for guidance. System -- - i Partition tame wan HEAVY DUTY LID _ "- t'zI CUTAWAY `. - a` Reinforced - I 24" structural - w ., %f access port I 1 W .f Structural ' bulkheads ' .�, "�. MID-SEAM CUTAWAY ti ,,,,T 4 t' ' Reinforced water tight mid-seam ' n gasketed connection >. rp I r NA INFILTRATOR" Protecting the Environment with Innovative Wastewater Treatment Solutions IM-1060 General Specifications and Illustrations urn NG STRAP mrkao ILIFTING OMOO°` nwIALl„moo-Tory The IM-1060 is an injection molded two piece mid-seam 4 - - - - - -y-.,•� plastic tank.The IM-1060 injection molded plastic design C �$=o'Lr allows for a mid-seam joint that has precise dimensions A .ialSAIAWe 1 • •7— for accepting an engineered EPDM gasket. Infiltrator s rVl. ��1 t r r �o \\ea iy_ gasket design utilizes technologyfrom the water industry 1l 40 , "�r ri I— • - B 9 rY - o , . , 0 1---F to deliver proven means of maintaining a watertight seal. 'lc %_%a t r li lam.%.__% w WIDTH The two-piece design is permanentlyfastened using a ' m - +1 . a3� series of non-corrosive plastic alignment dowels and • IR I locking seam clips. The IM-1060 is assembled and sold through a network of certified Infiltrator distributors. III A,,,,aILk,La,ekLtKa,. Must be backfilled and installed in accordance with TOP VIEW Infiltrator Water Technologies, Infiltrator IM-Series SeptA nn,L„ Tank General Installation Instructions and for shallot{ F•J P R O V E p - ground water conditions reference the Infiltrator IM- • Series Tank Buoyancy Control Guidance. FEB O 9 2024 /. . I. I c Please visit www.infiltrat�rwateccom/images/pdt45oY i,IJJ 1 'p1E40VM F4 AL H If ^VI;; HEFO ManualsGuides/TANK01. df for the latest information. / "`r"` M-1060 L, Working Capacity 1094 gal(4141 L) LIFTING STRAP Total Capacity 1287 gal(4072 L) END VIEW Airspace 16.5% Length 127"(3226 mm) a4109 a ealnwl ACCESS OPFNwcsvonl LOCKING LIDS m Pot OR ABS a 411021 PVC OR 1 Width 62.2" u (1580 mm) IRrTff I0 E126DuamoA6b ASSOUTLETTEE Length-to-Width Ratio 2.3 to 1 iii FT Sn. o nef T. IHeight 54.7"(1389 mm) mpe nmJ Liquid Level 44"(1118 mm) CO I . Invert Drop 3"(76 mm) FIBERGLASS 'SUPPORT — IDEPIH — _. -- Or9,Gl1 DEPTH .Dieu Fiberglass Supports 2 I awL%Amfpk I �, 4r. . _ Compartments 1 or2 _ , Maximum Burial Depth 48"(1219 mm) SIDE VIEW Minimum Burial Depth 6"(152 mm) Maximum Pipe Diameter 6"(152 mm) TANK TOP CONTINUOUS I Weight 320 lbs(145 kg) HALF GASKET TANK II *+'�t INTERIOR I® +J�- SEAM CLIP ALIGNMENT DOWEL TANK BOTTOM 4 Bwineas Palk Road HALF P 0.Boa 768 Old Saybrook.CT W475 INFILTRATOR' 860-57Y-0000•Fax 860-5"-'WI MID-HEIGHT SEAM SECTION 1dao-221-4436 ,, www.iniltratorswatercom U.S.Patents 5966I 5017..04 556,488;5335,0 0 . 16.5,4m.635s11,903s 5. 6, BS 5,88.78 5833.344 canad,an Patents 1,329.959.2,004564 Other patents S . r.EgUalEer. Ouick4.and SueWnderae registered trademarks of Infiltrator Water Technologies.In Seater➢aregistered trademark in Franca Infiltrator Water Technologies is a registered trademark in Merca Contour.htieroLeathing,PolyTult.ChamberSoacea MutiPdI Posfrock,OuickCut.OmckPlay.9naptttk and StraigntLock are trademarks of Infiltrates Water Technologies. PolyLOKs a trademark of PolyLok.Inc.TUF.TITE s a registered trademark of T F-TITE,INC.Ultra-Rib is a trademark o1 IPEx Inc ®20i6 Infiltrator Water TechnologK LTC.Al rights reserved Printed in U.S.A. IM021`I6 Contact Infiltrator Water Technologies' Technical Services Department for assistance at 1-800-221-4436 , ( oI )31kGDiaa - rs`&"APPROVED FEB 09 2024 — firittly ;n 2,4..- NAscN C^,uti-r 1��4'�; LA HEALTH ' .. ao1 L1 .n, — .G ,t.'2. 1:I(I ..; i - . .. : t' ?I:: o Tr/ 8 i1) I , KOITA3 t' ,, V ric�i.x t t - L:bbssicn z tie..-:.. 214:iA zc ,;cn7: c e:-c .:.• :m.:0 �;ta9a.,..a c: . ruP. \ � aehfl u � r:Li 4P9ZUT 0 III :;� U ^0.�. _ .r o1 FflOLfl9t4' blI1ciae II r4tir ct 10S rooaf .�hfi` t+, i� . . : �� a _ ., . ^ 3 r n fiat' L.- ; '-n.rj :",,-.43 -A; tU '_. tft cC )oTtse r ar crA. /�� ) 11 I ___. _ .( :'3YGiictA �.._ bevo-,ggA. etra Printed From Mason County t ` -S Printed from Mason County DMS , p RECORD DRAWING (ASBUILT) pg. 1 MASON COUNTY PUBLIC HEALTH PARCEL IDENTIFICATION Permit Number SWG „2v214' 'QODig— Assessor Parcel # 7)2 snot 6 k 0 60 6.6 Applicant Name 6-0t-4- + S- 5J C�}rc Subdivision (Name/Div/Block/Lot) U Applicant Address PO OOX I 1 City, State, Zip 0144Nocic-/ )1/fY 1e56o Installer Name Gc :25pn Site Address '1 1 kf./2c{4 `x✓'It/ Designer Name INSTALLATION CHECKLIST ❑ Full System Installation pf Septic Tank Only ❑ Drainfield Only ❑ Repair System Type c.v.-NA-1 Pretreatment Type >5 ft. from foundation? - - - - - ❑ N/A / YES ❑ NO >50 ft. from wells? - - - . - - - - ❑ 0 ❑ Z >50 ft. from surface water? - - ❑ B ❑ FCleanout between building and tank? - - - - ❑ ❑U Tank baffles present? - - ❑ 7i ❑ F- 24" access risers over each compartment? ❑ CJ ❑ W Effluent filter installed?- - ❑ VI ❑ N J, / ,{— Septic tank size IC W �u0' gal Manufacturer " ❑ D-box water level and speed levelers used? • -- - - - - ❑ N/A ❑ YES ❑ NO oJ O Manifold/D-box accessible from surface?- - - - - ❑ ❑ ❑ u. n?Z Check valves installed? - - - - - - - ❑ ❑ ❑ ❑Q 2 Transport Line Size Schedule/Class Bedrooms installed (check one)g I ❑ 2 ❑ 3 ❑4 ❑ 5 ❑6 >10 ft. from foundaation? - - - - - ❑ N/A ❑ YES ❑ NO >100 ft. from wells?- -- - _. - - ❑ ❑ ❑ o W >100 ft. from surface water? - - ❑ ❑ ❑ LT >10 ft. from potable water lines?- . ❑ ❑ ❑ Z a > 5 ft. from property lines and easements?- • - - - ❑ ❑ ❑K > 30 ft. from downgradient curtain/foundation drains? - - ❑ ❑ ❑ o Drainfield level and observation pods present - • ❑ ❑ ❑ ❑ Graveless chambers or ❑ Clean gravel used? (check one) Proper cover installed over drainfield?- - - - - - ❑ ❑ ❑ Pump tank setbacks consistent with septic tank? - -- ❑ N/A ❑ YES ❑ No • Pump tank size gal Manufacturer ZQ 24" access riser(s)and accessible from surface? ❑ ❑ ❑ F- Q. Alarm or Control Panel Installed? - ❑ 0 ❑ 2 Control Panel equipped with Timer/ETM /Counter- - ❑ ❑ ❑ D a Pump installed in ❑ Bucket or ❑ On Block or ❑ Other O.n Pump Make/Model ❑ Floats or ❑ Transducer 0. a Tank draw down in/min Pump capacity gpm Squirt Height ft Pump on time Pump off time Daily flow set at gpm revised 1222C14 RECORD DRAWING (ASBUILT) pg. 2 MASON COUNTY PUBLIC HEALTH RECORD DRAWING • Drainfield& manifold orientation /� t, ( _e, (A f "{ &layout ❑ Trench/bed dimensions and critical distances within layout • Septicipump tank placement ▪ Location of buildings ▪ Observation ports& clean-out locations ❑ Location of wells, surface water,& roads ❑ Undisturbed native soil between trenches ❑ North Arrow If the designer or installer feel the need for additional information/comments, it may be attached. Record drawing may also Le on a seperate page attached. No. Pages Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER I certify that I installed the system in accordance with I certify that the system has been installed in accor- the septic design stamped"APPROVED"by Mason dance with the septic design stamped "APPROVED"by County Public Health and that any deviations shown Mason County Public Health and that any deviations here have been cleared/approved by both the designer shown here have been cleared/approved by both and Mason County Public Health and meet all State myself and Mason County Public Health and inset all and Mason County Codes. State and Mason County Codes I further certify that all information contained on this 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. Sign to ,of Installer Date JL.Vu, Gel Printed Name of Signee MASON COUNTY PUBLIC HEALTH The undersigned approves this Installation Report and Record Drawing on behalf of Mason County Public Health: Signature of Environmental -lealth Specialist Date (designer's stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE revised v22rz014 '; yk (. D . z rsCr,KL i o c ,1 ,- • nor n 0„ r ETICS .,_I• Ic S:.d.fizit ra 7 I' ! T3U3' 'EA)) i EOITA:_ t .:vf/ Intiv xc vni. \ Telly L_r:7 �•� ; ih, .-dI- •c32ucol. lo RF o; fi r _ - _ en or eno< re y.• bc,I1 7aQ n rt. ram CS rt.L 'eW c�,(,-r -t4-L) IQ"(LiCL ... __t --f�. k\ o .. _ 1�-�. %<: k (l"i ) ^YI�11.cTry i"u1a--. . lL)� f r 43 ti ct5 v✓i7tr,a 4 I ---. .t(V�^sl,_f. 1Fehi r ti J i r • PRp OV rt e' ;: . Ee o E G l L'e 4 :CtE-- _r _.. . ::._ u'l "lI NYEN-At HE?tl L.; icy w — — - l __.. _._. -__—. �._ - .f tik _ Cr: : -PringgA hew—uwit etuG Printed From Mason County I S Printed from Mason County DMS