HomeMy WebLinkAboutSWG2023-00537 - SWG Application / Design - 12/29/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,
967 ,WA 98584
SHELTON:360-427-9670, EXT 400
~ BELFAIR:360-275-4467,EXT 400
. ^ 0 Public Health & Human Services ELMA:360-482-5269, EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2023-00537
APPLICANT TRAVIS MARY JANE Phone:
Address: 7400 ASHRIDGE AVE SW PORT ORCHARD, WA 98367
OWNER TRAVIS MARY JANE Phone:
Address: 7400 ASHRIDGE AVE SW PORT ORCHARD, WA 98367
SEPTIC DESIGNER Alex Paysee Phone: 360-426-1803
Address: 3083 E Mason Benson Rd GRAPEVIEW, WA 98546
Site Address: 920 E Maples Rd
Primary Parcel Number: 220234400010
Permit Description: 3-bedroom pressure system
Permit Submitted Date: 12/29/2023
Permit Issued Date: 02/07/2024
Issued By: David Anderson
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 01/10/2027 (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/onsiteloss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY J �/�
MASON COUNTY DATE RECEIVED: 11� � iQ4 /
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COMMUNITY SERVICES AMOECEN . REECEEIIIVEl•Y: ` ii,�/�� CI)
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Public Health(Community Health/Environmental Health) O Q7/
360 427 9670.ext 400.360.275-4467,ext.400 �''') • cn
415 N.6th Street•Shelton,WA 98584 S G — 0 fl S -to-
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ON-SITE SEWAGE SYSTEM APPLICATION D D
APPLICANT fl'1
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MARY TRAVIS Z
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MAILING ADDRESS-STREET.CITY.STATE,ZIP CODE
7400 ASHRIDGE AVE. SW. PORT ORCHARD WA 98367 CO
XI
SITE ADDRESS-STREET,CITY.ZIP CODE ••
920 E MAPLES ROAD SHELTON WA 98584 I ("
NAME OF DESIGNER PHONE N
ALEX L PAYSSE 360-426-1803
NAME OF INSTALLER PHONE I Q
TBD
PERMIT{ TYPE(select one) DRINKINGIN WATER SOURCE - I N
1�'I RESIDENTIAL OSS COMMUNITY OSS II I COMMERCIAL OSS 110�PRIVATE INDIVIDUAL WELL ff PRIVATE TWO-PARTY WELL Z I CO
TYPE OF WORK(select one) ]PUBLIC WATER SYSTEM
Mr NEW CONSTRUCTION/UPGRADES ft REPAIR/REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR 14'.
SUBMITTALS�MI ❑ SURFACING SEWAGE 0 EXISTING FAILURE ❑SHORELINE
M DESIGN FORM(REQUIRED) (ASEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE � I -P
l� ( ) APPLICABLE) TWO 2.23 ACRE o I
Lte WAIVERS (IF x I Q
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex locked gate)
NORTH HWY 3. RIGHT ON PICKERING RD, FOLLOW TO HARSTINE ISLAND. FOLLOW ACROSS I O
BRIDGE TO INTERSECTION AND TURN RIGHT ON SOUTH ISLAND DRIVE.AT INTERSECTION TURN
RIGHT AGAIN ON HARSTINE ISLAND RD SOUTH. AT HARD LEFT TURN, STAY STRAIGHT ONTO p I O
MAPLES RD. FOLLOW GRAVEL ROAD TO SITE ADDRESS 920 AND PDI SIGN. SEE SITE PLAN, DF LEFT -1
OF MAPLES & TANKS ON RIGHT. MAY USE NEIGHBORS DRIVEWAY(SHOWN ON SITE PLAN)TO I
ACCESS TEST HOLES.
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I O
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS COMMENTS/CONDITIONS
vivo - A?" f715
WI- at SS" 4l n+uf . r(I a•F 00"
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SOIL CODES: RECORD DRAWING AND INSTALLATION REPORT
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL.
INSPECT SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
— 17/c(?0,2 I /1D/70 7 . - -1911f 2/?/
`
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/72015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 0 2 3 — 4 4 — 0 0 0 1 0
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
'1 Scaled plot plan,including all applicable items on checklist. 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"
PARCEL IDENTIFICATION,jj �'
,
Permit Number: SWG 13-00 ? Designer's Name: ALEXL. PAYSSE
Applicant's Name: MARY TRAVIS Designer's Phone Number: 360-426-1803
Mailing Address: 7400 ASHRIDGE AVE.SW. Designer's Address: 3083 E MASON BENSON RD
PT ORCHARD WA 98367 GRAPEVIEW WA 98546
City State Zip City State Zip
DESIGN•PARAMETERS .''. ...' -.
Treatment Device
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
❑Gravity ErPressure FETrench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 c Schedule/Class SCH.40 •
Daily Flow: Operating Capacity 180 v gpd Length 40+40+20 ft
Daily Flow: Design Flow 240 ! gpd Diameter 1.25 in
Septic Tank Capacity(working) 1500 ' gal Number 3
Receiving Soil Type(1-6) 3 ' Separation 9+ ft
Receiving Soil Appl.Rate 0.8 ' gpd/ft2 Orifices
Required Primary Area 300 ft2 Total Number of Orifices 25 _
Designed Primary Area 300 ft2 Diameter 3/16 in
Designed Reserve Area 300 - ft2 Spacing 48 in
Trench/Bed Width 3 ! ft Manifold
Trench/Bed Length 100 ' ft Schedule/Class SCH.40 -
Elevation Measurements Length 30 ft
Original Drainfield Area Slope 12 % Diameter 1.25 in
New Slope,If Altered 12 % Preferred manifold configuration used? lifYes 0 No
Depth of Excavation Up-slope 12 in Transport Pipe
from Original Grade Down-slope 8 in Schedule/Class SCH.40
Designed Vertical Separation 24+ Vin Length 520 ft
Gravelless Chambers Required? 0 Yes It No 0 Optional Diameter 2 in
Pump Required? Eli Yes ❑No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 4
Diff. in Elevation Between Pump&Uppermost Orifice 78 ft Dose quantity 60 - gal
Drainfield Squirt Height/Selected Residual(head) 2 ft Chamber Capacity(flood) 1500 /- gal
Uppermost Orifice litfHigher 0 Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head 15 gpm I'Timer It 'Elapse Meter l 'Event Counter
Calculated Total Pressure Head 88 ft If Timer: Pump on 2.5 MIN ,Pump off 6 HRS
Comments
PERFORM DRAWDOWN AFTER INSTALL AND ADJUST TIMER SETTINGS ACCORDINGLY.
r
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 2 0 2 3 — 4 4 -- 0 0 0 1 0
Permit Number: SWG
DESIGN CHECKLISTS Je
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sket RFC ?/
ltili Test hole locations Gd Drainfield orientation and layout Reference depth from origina _ .F0
g Soil logs g Trench/bed dimensions and g Septic tank
g Property lines critical distances within layout Z Drainfield cover
66 Existingand proposed wells G� D-Box/Valve box locations
P P Reference depth from original grade
within 100 ft of property g Septic tank/pump chamber and restrictive strata:
Q1 Measurements to cuts,banks,and locations g Laterals,trench/bed,top and
surface water and critical areas g Observation port location bottom
g Location and orientation of g Clean-out location 0 Curtain drain collector
curtain drain and all absorption It Manifold placement 0 Sand augmentation
components
g Orifice placement Other cross-section detail:
10 Location and dimension of g Lateral placement with distance g Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
10 Buildings g Audible/visual alarm referenced Yes No
21 Direction of slope indicator g Scale of drawing shown on scale g C� 0 Design staked out
6Q Waterlines bar 0 l 'Recorded Notices attached
1 Roads,easements,driveways, g 0 Waiver(s)attached
parking I ' 0 Pump curve attached
g North arrow and scale drawing 0 1I Evaluation of failure
shown on scale bar Non-residential justification
❑ Iii Waste strength
❑ l Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer at time of installation g Yes 0 No
4 1/18/2024
Signature of signer Date
ASP�
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it'ta►lOIV
compliance with state and local on-s. gulations.
Zl ?t20 Z''/i0N FEB 0 7 2024
Environmental Health Specialist Date OOUN'''ENV
p DJ
gONMENTAC HEACTh
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved" by Mason County Public Health. /0/zo ��
✓ 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 Dale: 12/7/2015
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PIONEER DIGGING, INC. CUSTOPARCEL^#:220ER: 23-4-44-00010Y � FEB 0 7 2024
SEPTIC DESIGNS ADDRESS: 920 E MAPLES RD MASON COUNTY ENVIRONMENTAL HEALTH
1083 E MASON BENSON RD. GRAPEVIEW,WA 985* DESIGNER: ALEX L.PAYSSE
OFFICE 3604261803 FAX 360-4272353 SHEET: CALLS SCALE NA DJA
Installation & System Notes
1. Installer must contact designer for final inspection of the installation prior to cover. All components, including tanks, lids,
transport line, drainfield, and water lines must be open for inspection. A$300.00 fee will be charged for time involved with the
inspection of the installation and creation of the record drawing. The designer reserves the right to charge additional fees if
multiple visits are needed due to installation errors or inaccessible components.
2. This septic design must be installed by a certified installer with the local health department. All components shall be installed
according to state, county,and manufacturer requirements. For Homeowner Installs,the owner must get approval from the
designer and local health department prior to attempting installation.
3. Designer is not a surveyor. Installer must familiarize themselves with property line locations prior to installation. Any
confusion or conflicts with line locations should be reported to the property owner. A licensed surveyor may be necessary prior
to installation to confirm all line locations. Any discrepancies found must be reported to the designer immediately.
4. Drainfield area may only be cleared by a licensed installer familiar with sensitive drainfield area preservation. The builder, lot
developer, or property owner shall not clear the drainfield area. Any clearing required for drainfield installation shall not
remove or disturb any top soil in Primary and Reserve areas. Removal or disturbance to drainfield soils could render design
void.
5. The property owner and installer are responsible for locating all underground utilities (ex. water,gas, electric) prior to
installation. Any utility locations shown within design drawings are likely approximate and may not be exact.
6. All proposed tanks must be installed on original soils or compacted gravels. Extend all tank connection lines out onto original
soil to avoid settling issues. Risers and lids must be brought to finished grade and left accessible for future operations and
maintenance. Component manufacturers (ex. ATU, Glendons,) may have other requirements not listed within this design.
7. All electrical wiring shall be done by a licensed electrician or homeowner(if allowed) and must be permitted through Labor
and Industries.
8.The proposed septic system should be installed in dry weather conditions. Any failed attempts at installation during wet
weather conditions may render this design void.
9. Maintain loft to waterlines with all septic components. If less than loft is required, sleeving in sch.40 pvc is required. If
sewage transport lines and waterlines must cross, waterline must be 18" above sewage line with one of the lines sleeved in sch.
40 pvc 10ft in each direction of crossing.
10.This design may include waiver applications with specific mitigation measures pertaining to installation,operation and
maintenance of the proposed components.
11.Stormwater runoff,footing drains, roof drains must be diverted away from any septic system components. No curtain,
foundation, perimeter drains shall be installed 30ft downslope and 10ft upslope of drainfield areas.
12.This design is site specific and intended to meet state and county requirements that are related to the system components
being proposed. Any placement of proposed buildings, proposed wells or other non-related items on these drawings may or
may not meet other requirements.
13. All onsite septic systems require regular maintenance to verify satisfactory operation. The system owner/operator is
responsible for the continuous operation and maintenance of the system per WAC 246-272A. For operation and maintenance
information, refer to Mason County Public Health Homeowner's Manual,which should be received afi' r';ij a)ipap royal.
14. System owner should be cautious of landscaping around septic components. Root intrusion
can cause premature failure of the drainfield area. In addition, bushes and trees should be kept FEB•
away from lids and other septic maintenance points. �f O,2024
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CUSTOMER: MARY 7RAVLS • f. ` ?t
PIONEER DIGGING, INC
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PARCEL#:22023-44-00010
SEPTIC DESIGNS ADDRESS: 920 E MAPLES RD "terLOUS
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3083 L MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ALEX L PAYSSE
OFFICE-360-4261803 FAX-360-427-2353 SHEET: NOTES SCALE NA s