HomeMy WebLinkAboutSWG2024-00012 - SWG Application / Design - 1/8/2024 nellia 584
MASON COUNTY 415"6 SHELTON: ,SHE7-967 ,EXT 400
SB STREET,
,SHEL-967q EXT 400
BELFAIR'.360-275-4467,EXT 400
Public Health & Human Services ELMA:360-482-5269,EXT400
FAX.360-427-7787
On-Site Sewage System Permit: SWG2024-00012
APPLICANT JIMENEZ BENITO Phone:
Address: 21 E WARREN DR UNION,WA 98592
OWNER JIMENEZ BENITO Phone:
Address: 21 E WARREN DR UNION, WA 98592
SEPTIC DESIGNER DALE TAHJA-Septic Designer Phone: 360-426-5940
Address: 2450 W DEEGAN ROAD WEST SHELTON, WA 98584
Site Address: 21 E WARREN DR
Primary Parcel Number: 322325500021
Permit Description: Repair-2BR Gravity
Permit Submitted Date: 01/08/2024
Permit Issued Date: 01/18/2024
Issued By: Jeff Wilmoth
Current Permit Fees Paid: 6805.00 (additional lees may be required upon installation of system).
Permit Expiration Date: 01/17/2027 based on date of nspection)
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 back(ll 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/environmentallonsiteloss-inspection-request.php or call:
360-427-9670,extension 400.
OFFICIAL USE ONLY
MASON COUNTY DMFBELI
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COMMUNITY SERVICES REWIRED� ° 03
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ON-SITE SEWAGE SYSTEM APPLICATION 3 z
APPLICANT PHONE m m
Benito Jimenez (360) 490-2459 C z
MAILING ADDRESS-STREET CITY,STATE,ZIP CODE G ;
21 E. Warren Dr. Union WA 98592 ° z
ADDRESS �E n
E. Warren Dr. Union WA 98592
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NAME OF DESIGNER PHONE CP I N
Dale L. Tahja (360) 426-5940
NAME OF INSTALLER PHONE a I N
T.J. Goos (360) 490-0217
PERMITTYPERMp EI
'' (sells/On 0.)e) CC DRINKING WATER SOURCE w I
W!RESIDENTIALOSS COMMUNITY OSS EGOMMERCLALCOMMERCIAL OSS 1ElPRIVATEINDIVIDUALWELL 5 PRIVATE TWO-PARTY WELL 2 IN
m TYPE OF WORN(Salad re yy.
) PUBLIC WATER SYSTEM PUD SI
EINEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(Owl an Ow alwy) 0 TABLE IX REPAIR I °1
SUSNITTALS O SURFACING SEWAGE 0 EX/STING FAILURE ❑SHORELINE 21
'DESIGN FORM(REQUIRED) USEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r Icn
57WAIVER(S)OF APPLICABLE) 2 0.46 acre S , ,
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex bOAN pate)
From Shelton, take Truck Trail north to Union, go past 5th Ave, turn right on Warren Dr., I I O
first property to the left (Union Landscaping) c I O
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SITE MUST BE MDDEDFROM MAIN ROAD AND TEST MOLES MUST RE FLAWED MTh TEST HOLE NMeERS. I
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE,FAILURE SOURCE Sof reporting purposes)
0 VOLUNTARY O MAINTENANCE/PUMPING 0 BUILDING PERMIT OHOME SALE OCOMPIAI NT °OTHER'. Y
INSPECTOR SOIL LOGS COMMEM$/CONDITIONS a(�
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RECORD DRAW NOAND INSTALLATION REPORt
SOIL CODES:
V-VERY G=GRAVELLY S=SAND L=LOAM Si=SILT L-CLAY Ea EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
I CTOR SIGNATURE DATE APPLICATION EXPIRATION DATE TDATE
YB I �� Y 1 HE �s / LROl<< ' l ( ATEy
MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY APP NAPPROVEDI ISSUED BY NTY WEBSITE (� REVISED 1217U015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 2 3 2 — 5 5 — 0 0 0 2 1
A design will be reviewed when 3 conies of each of the following are submitted:
v Completed design form that has been signed and dated. a Scaled layout sketch,including all applicable items on checklist
O Scaled plot plan,including all applicable items on checklist. v 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: 11"X 17"
Permit Number: SWG )-i] 2, '— COd li Designer's Name: Dale Tahja
Applicant's Name: Bonito Jimenez Designer's Phone Number (360)426-5940
Mailing Address: 21 E.Warren Dr, Designer's Address: 2450 W Deegan Rtl W
Union WA 98592 Shelton WA 98584
City State Zip City State Zip
``+ DESCC+NQikBATERS'>
Treatment Device
❑Glendon Biollter. 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: N/A
Drainfield Type
CiGravity 0 Pressure RI-french 0 Bed 0 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)b-C 1 fQ '� gal Number 3
Receiving Soil Type(1-6) 4 Separation 5 ft
Receiving Soil Appl. Rate 0.6 gpd/ft' Orifices
Required Primary Area 400 ft2 Total Number of Orifices Gravity
Designed Primary Area 400 ft2 Diameter NIA in
Designed Reserve Area 400 ft2 Spacing N/A in
Trench/Bed Width 3 ft Manifold
TrenchBed Length 135 ft Schedule/Class 3034
Elevation Measurements Length 20 ft
Original Drainfield Area Slope 9 ok Diameter 4 in
New Slope,If Altered 7 % Preferred manifold configuration used? D Yes ]No
Depth of Excavation Up'slope 9 in Transport Pipe
from Original Grade Down-slope 6 in Schedule/Class 3034
Designed Vertical Separation 24 in Length 40 ft
Gravelless Chambers Required? 0 Yes 0 No FiOptional Diameter 4 in
Pump Required? ❑Yes MNo Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day Gravity
Diff in Elevation Between Pump&Uppermost Orifice ft Dose quantity N/A gal
Drainfield Squirt Height/Selected Residual(head) ft Chamber Capacity(flood) N/A gal
Uppermost Orifice 0 Higher D Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head Graravityw a�gpprn OTimer DElapse Meter 0 Event Counter
Calculated Total Pressure Head 1p C ® '�f a``Ti • ump on N/A ,pump off NIA
Comments
JAN 1 8 21124
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DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 2 3 2 — 5 5 -- 0 0 0 2 1
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Wi Test hole locations WI Drainfield orientation and layout Reference depth from original grade:
69 Soil logs g Trench/bed dimensions and It Septic tank
67 Property lines critical distances within layout RI Drainfield cover
6d Existing and proposed wells 61 D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 6d Septic tank/pump chamber and restrictive strata:
6d Measurements to cuts, banks, and locations 0 Laterals,trench/bed,top and
surface water and critical areas 61 Observation port location bottom
WI Location and orientation of 21 Clean-out location 0 Curtain drain collector
curtain drain and all absorption 6I Manifold placement ❑ Sand augmentation
components 0 Orifice placement Other cross-section detail:
67 Location and dimension of 64 Lateral placement with distance WI Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
66 Buildings 0 Audible/visual alarm referenced Yes No
El Direction of slope indicator Ed Scale of drawing shown on scale RI 0 Designstaked out
61 Waterlines bar 0 ❑Recorded Notices attached
y
61 Roads,easements,driveways, ❑ ❑ Waiver(s)attached
parking P P R 01� E .. 0 0 Pump curve attached
&1 North arrow and scale drawing ❑ 0 Evaluation of failure
shown on scale bar Non-residential, '[UI9
Non-residential justification
NASONCGUNTI ENVIRON::IENTA! kFp i-- 0 0 Waste strength
JBW ❑ ❑Flow
DESIGN APPROVAL
The undersigned designer must be notified is eF at time of installation RI Yes ❑ No
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Signature of Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health and dete r '� < u 6
compliance with state and local on-si - -.. <•'-'ations: p;a`` ?,,4,r--
ens . (rn ,it f-(:? *fie $;5
,r Envirirn 79i ealthSpecialist Date N.r;S d c
CAUTION: DESIGN APPRO AL IS VALID ONLY UNDER THE FOLLOWING COND'K
✓ The design is stamped"Approved"by Mason County Public Health. ,,/ fi },
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: i — 1 .5 4Xs;.,
✓ 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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Installation/Maintenance
Gravity Distribution/Trench Systems
1. Install trench bottom level and in contour with the ground.
2. Install drainfield during dry weather and soil conditions.Any soil smearing must be
eliminated by hand raking any areas that get smeared.
3. Divert all storm water run-off away from septic system components.
4. No curtain (french) drains allowed within l Oft. of the up-slope edge of the drainfield and
reserve area.
5. No curtain(french) drains allowed within 30ft. of the down-slope edge of the drainfield
and reserve area.
6. Have the septic tank pumped or inspected every 3 to 5 years.
7. All material and workmanship must meet County and State requirements.
8. Install risers on septic tank.
9. Deviation from this approved design without prior approval from the Designer and
Mason County Health Department will make this design null and void.
10.The prepared Site Plan is not a survey, it is the owner's responsibility to verify property
line locations prior to installation. Any discrepancies must be reported to the Designer
immediately.
11.Locate all utilities prior to starting installation.
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