HomeMy WebLinkAboutSWG2023-00520 - SWG Application / Design - 12/12/2023 415 N 6TH STREET,SHELTON.WA 98584
MASON COUNTY SHELTON:360275-4467 EXT 400
BEr7LFAIR:ELMA:360-482-6269,EXT 400AIR'.360 2]5-446],EXT 400
Public Health & Human Services FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00520
APPLICANT
KENNEDY SADIE Phone: 360-265-4370
Address: 51 NE Lynnwood Beach Rd BELFAIR,WA 98528
OWNER
KENNEDY SADIE Phone: 360-265-4370
Address: 51 NE Lynnwood Beach Rd BELFAIR,WA 98528
Jim ZimnyPhone: 360-516-7287
SEPTIC DESIGNER
Address: 7178 WINDFLOWER PL NW SEABECK, WA 98380
Site Address: 51 NE Lynnwood Beach Rd
Primary Parcel Number:
222012300140
Permit Description: 2-bedroom gravity system for second SFR (no basement)
Permit Submitted Date: 12112/202301/22/2024
Permit By: Date: David Anderson
Cubed By: $525.00 (additional lees may be required upon Installation of system).
Current Permit Fees Paid:
Permit Expiration Date:
1 211 412 0 2 6 (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. for a
6 ***No basement for proposed residence. Waiver WA12024-00009 approved
residence without a basement and may be revoked if a basement is constructed.***
7 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: masoncountyw3 02�9670e extension n400-Dsiteloss-inspection-request.php or call:
OFFICIAL USE ONLY
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CLEAR FORM ON-SITE SEWAGE SYSTEM APPLICATION ao
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MAILING ADDRESS.STREET,CITY STATE ZIP CODE g
PO Box 2206, Belfair Wa 98528 m
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SITE ADDRES. •STREET CITY.ZIP CODE
51 L NNWOOD BEACH Rd. BELFAIR WA 98528
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NAME OF DESIGNER PHONE
Jim Zimny 360-516-7287
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PHONE v
NAE OF INSTALLERIZ
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DRINKING WATER SOURCE Q
PERMIT TYPE. ann) rl PRIVATE INDIVIDUAL WELL PRIVATE TWO-PARTY WELL Z I—
PIRESIDENT11 ALOES II COMMUNITY 055 mCCM1MERCIAL 055 ,a PUBLIC WATER SYSTEM I Ni
YPE0/ = ( Y'a''a)
iT NEW CONSTRUCTION/UPGRADES rI REPAIR/REPLACEMENT OTHER
OB SURFACING SEWAGEM/❑EXISTING) 0 FAILURE IXREEURO SHORELINE
SUEMIDESI
03
VI SEPTIC DESIGN(REQUIRED) OEDROOMS oT NZE .27 Acres o
MI DESIGN FORM(REQUIRED) 2
YT VaIVER(S)(IF APPLICABLE) A I O
DIRECTIONS TO SITE AND SITE CONDITIONS (ex keiedgale)
From Belfair go 3.2 miles on Northshore rd to beck Rd take left. Follow .2 miles to Lynwood I 0
Beach Rd. site is 300 ft on left. Marked with address. o
Dog and locked fence onsite, please call designer to schedule site visit.(360 516-7287 IC
SITE MUST OE FLAGGED PROM MAIN ROAO ARO TEST HOLES MIST BE FlA aO WOW!MIDDLE NUMBERS
_ OFFICIAL USE ONLY BELOW THIS LINE- -
FAILURE SOURCE(for repent.°pwpe e)
UPGRADE
VOLUNTARY O MAINTENANCE/PUMPING ❑BUILDING PERMIT OHOME SALE OCOMPWNT OOTHER
U
SOIL
MMENTSICONDII IONS
15L Qt
led AT
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fN4:0-35 F51-
3J,bp, I VC? the s fie5fA RECORD DRAATNG AND INSTALLATION REPORT
Sot CODES'. ---YYY ✓✓ REWIRED FOR FINAL APPROVAL
V+VERY G=GRAVELLY S=SAND L-IOAM Si SILT IG=CLAYI E=EXTREMELY R=ROOTS N DATE PREOUIRI ROVED ISSUED BY DATE
INSPECTOR PTRE� �� DATE AFPLIGZATI�NE�RAI ��
THIS FO MMAY BE SCANNED AND VAILASlE F011 PUSLN:VIEW ON THE MASON COUNTY WESSIIE
REVISED 121I12015
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DESIGN FORM-PAGE ONE Assessor's Parcel Number 222012300140- -
A design will be reviewed when 3 amigo of each of the following are submitted:
v Completed design form that has been signed and dated. Scaled layout sketch.including all applicable items on checklist
't Scaled plot plan.,including all applicable items on checklist Crass-section sketch,including all applicable items on checklist.
This form may be scanned and available for public view an the Mason County Web site,Maximum paper size: II-X!7"
PARCEL IDENTIFICATION I
1I Jim Zimny
Permit Number SwG 762 - OG D Designer's Name:
Sadie Kennedy360.616-7267
Applicant's Name: Designers Phone Number
PP 7178 WNdflo er pi NW
PO Box 2206 Designers Addres:
Mailing Address: Seabee* WA 98380
Ballot* WA 9�2a
CLEAR FORM City State Zip
City State Zip I
DESIGN PARAMETERS
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound ❑Sand Lined Drainfield ❑Recirculating Filter,Type:
0 Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Odor.
Drainfield Type ❑ Sub Surface Drip
!'Gravity 0 Pressure ❑Trench Elf Bed i
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms -
2 Schedule/Class 3034
UO ft
Daily Flow:Operating Capacity 180 / gpd Length
Daily Flow: Design Flow 240 — gpd Diameter inr 3
Septic Tank Capacity (working) 1000 gal Number 3 ft
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Receiving Soil Type(l- ) V,I - Separation
•Receiving Soil Appi.Rate 04 Jet gpd/ft' Orifices
Required PrimaryArea 400 , ft2 Total Number of Orifices N/A
W -7�
Designed Primary Axa Y60 - ft Diameter in
Designed Reserve Area
`fob-7- ftz Spacing in
( tt
Trench/Bed Width 10 - ft /-� q Manifold
Trench/Bed Length _90 ft Scaed S Sc NA
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Elevation Measurements Le 1-4g O ft
'
Original Drainfield Area Slope 0 'YeDi;ci. I min-., , it in
New Slope,If Altered 0 % ;' 1.t- :4.1 • ion used? 0 Yes 0 No
Depth of Excavation cPrl°pe
24 ` in �anv k:r Tlransport Pipe
from Original Grade po w.,i0p, 24 in Schedule/Class 3034 -
h 10 ft— in Length Designed Vertical Separation 36 4 in
Gravelless Chambers Required? ❑Yes ET No D Optional Diameter
Pump Required? ❑Yes ElNo Dosing and Pump Chamber N/A `
day
Pump/Siphon SpecSpecificationsNumbcr of doses/ gal
DitT, in Elevation Between Pump&Uppermost Orifice ft Dose quantityal
Drainfield Squirt Height/Selected Residual(Mad) ft Chamber Capacity(flood) I g
Pump controls:Please chec1c those required.
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff OTimer pse Meter ❑Event Counter
Capacity Total Pressure Head gnat ,pump off
Calculated Total Pressure Head ft If Timer: Pump on
Comments ArTiPROV Lv
JAN222024
MASON COUNTY ENVIRONMENTAL HEALTH
DESIGN FORM—PAGE TWO Assssor s Parcel Number. 222012300140-- —
Permit Number SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
0 Test hole locations 0 Drainfield orientation and layout R♦ference depth from original grade:
0 Soil logs 0 Trench/bed dimensions and 0 Septic tank
O Property lines critical distances within layout sr Drainfield cover
El Existing and proposed wells 10 D-Box/Valve box locations Reference depth from original grade
within 100 ft of property le Septic tank/pump chamber and restrictive strata:
O Measurements to cuts,banks,and locations 0 Laterals,trench/bed,top and
surface water and critical areas 0 Observation port location bottom
O Location and orientation of 0 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption ❑ Manifold placement ❑ Sand augmentation
components ❑ Orifice placement Other cross-section detail:
O Location and dimension of e 1 ateral placement with distance 0 Observation ports/clean-outs
primary system and reserve area to edge of bed tither Information
O Buildings ❑ Audible/visual alarm referenced Yes No
PI Direction-of slope indicator 01 Scale of drawing shown on scale FI Design staked out
O Waterlines bar ❑ ❑Recorded Notices attached
0 Roads,easements,driveways, „ttrt ❑ ❑Waiver(s)attached
parking 4 ❑ 0 Pump curve attached
0 North arrow and scale drawing if
t . r y ❑ ❑ Evaluation of failure
shown on scale bar . Non-residential justification
V ❑ ❑Waste strength
e /aces�Gurr+ r ❑ ❑ Flow
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DESIGN APPROVAL
The undersigned designer must be notified by . "l. er me of installation 0 Yes ❑ No
12 20-Z;
Signature f per Date The undersigned has reviewed this design on behalf of Mason County Public Health and delA E P tRl())VE D
compliance with state and local on-sit lations: 1/7Z7Z0Z11 JAN222024
Environmental Health Specialist bateASON COUNTY ENpV�IR�nONMENiAI HEALiti
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITIM.
✓ The design is stamped"Approved"by Mason County Public Health. . i Z //t//742/
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: (// 7 C b
✓ Drainfield site conditions have not been altered to adversely affect conditions of design approval.
Please Note: The system must be installed by a cdrtified 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.
ted Date: 12i1Y1015
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Advantage Perc & Design
Construction Notes for Gravity Distribution bed for 2 Bedroom System:
Gravity Bed Distribution w/Rock and pipe
Install 10 x gip'bed.
Install 4 outlet d-box with an outlet pipe going to each infiltrator leg using speed levelers.
D box must have an access riser to the surface of the ground.
Install 24"deep and level in trench
Inctall in Annuoatha,.nnlu
Use 1000 Gallon W/water-tight secured risers to the surface of the ground. OZover
System designed for typical residential waste strength sewage only.
System designed for 240 Gallons Per Day psi ,l T'p1.4
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APPROVED
JAN 2 2 2024
MASON COUNTY EN ROWENTAL MEAL-El
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