HomeMy WebLinkAboutSWG2024-00021 - SWG Application / Design - 1/19/2024 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
j' 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: SWG2024-00021
APPLICANT VANDERBERG ROXANNE M Phone:
Address: 591 E BENSON LOOP SHELTON, WA 98584
OWNER VANDERBERG ROXANNE M Phone:
Address: 591 E BENSON LOOP SHELTON, WA 98584
SEPTIC DESIGNER Alex Paysee Phone: 360-426-1803
Address: 3083 E Mason Benson Rd GRAPEVIEW, WA 98546
Site Address: 591 E Benson Loop
Primary Parcel Number: 220215090031
Permit Description: New SFR-2BR Gravity Bed
Permit Submitted Date: 01/19/2024
Permit Issued Date: 02/13/2024
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $540.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 02/13/2029 (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
MASON COUNTYj7�JT DATE RECEIVED I i 19 I 0...0 .L u) D
•II• - COMMUNITY SERVICES AMOUNT RECEIVED' , / . RECEIVEDEY O m
Public Health(Community Health Environmental Health) + ����CCvC 1 { Q
, 360-4274ISN6th 70.Street Shelton,400 or WA
75 8584 ext.400 SVVG • � - � I O 2
a75 N.6th Street�Shelton,WA 9858a
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ON-SITE SEWAGE SYSTEM APPLICATION
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APPLICANT PHONE R1 m
ROXANNE VANDERBERG ;;(z ' , { / 62 Oo2 z
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MAILING ADDRESS-STREET CITY.STATE ZIP CODE g
591 E BENSON LOOP SHELTON WA 98584 m
SITE ADDRESS-STREET,CITY ZIP CODE
591 E BENSON LOOP SHELTON WA 98584 I 1`)
NAME OF DESIGNER PHONE I IV
ALEX L. PAYSSE 360-426-1803
NAME OF INSTALLER PHONE O
TBD
PERMIT TYPE(select one) DRINKING WATER SOURCE - I N
RESIDENTIAL OSS COMMUNITY OSS If I COMMERCIAL OSS g PRIVATE INDIVIDUAL WELL n PRIVATE TWO-PARTY WELL Z
TYPEP OF VVORK(select one/ M— PUBLIC WATER SYSTEM t
p[I NEW CONSTRUCTION/UPGRADES REPAIR/REPLACEMENT OTHER DETAILS(select ell that apply) 0 TABLE IX REPAIR C71
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE Q(SHORELINE
I�t DESIGN FORM(REQUIRED) V SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE I 0
�WAIVER(S)(IF APPLICABLE) 2 2.34 0 I co
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex locked gate)
N HWY 3, RIGHT ON AGATE ROAD. FOLLOW TO STORE AND CONTINUE LEFT ON o
AGATE RD. TURN RIGHT ON BENSON LOOP AND FOLLOW TO SITE ADDRESS 591 r
ON LEFT. PDI SIGN POSTED. CONTINUE DOWN DRIVEWAY TO HOME LOCATION, o 0
SEE SITE PLAN. I w
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE/FAILURE SOURCE(for reporting purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING 0 BUILDING PERMIT 0 HOME SALE ['COMPLAINT ❑OTHER:
INSPECT R SOIL S / COMMENTS/CONDITIONS
2 ee6 nos
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.
I I•Ee OR SIGNATURE DATE APPLICATION EXPIRATION DATE A I TION APPROVED/ISSUED BY DATE
.....„
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THil- � AY BE SCANNED AND.AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
/ �� ,451 4.4 el I /
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 0 2 1 — 5 0 — 9 0 0 3 1
A design will be reviewed when 3 copies of each of the following are submitted:
''Completed design form that has been signed and dated. "Scaled layout sketch,including all applicable items on checklist
''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: I I"X 17"
r PARCEL IDENTIFICATION
Permit Number: SWG ,01-�u—O(2 )2I. Designer's Name: ALEX L.PAYSSE
Applicant's Name: ROXANNE VANDERBERG Designer's Phone Number: 360-426-1803
Mailing Address: 591 E BENSON LOOP Designer's Address: 3083 E MASON BENSON RD
SHELTON WA 98584 GRAPEVIEW WA 98546
City State Zip CityState Zi
DESIGN:PATERS
Treatment Device
3
❑Glendon Biofilter 0 Sand Filter 0 Mound ❑Sand Lined Drainfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other:
Drainfield Type
!if Gravity 0 Pressure 0 Trench Si Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class 2729 PERF
Daily Flow: Operating Capacity 180 gpd Length 37.5 ft
Daily Flow: Design Flow 240 gpd Diameter 4 in
Septic Tank Capacity(working) 1200 gal Number 3
Receiving Soil Type(1-6) 3 Separation 32" ft
Receiving Soil Appl.Rate 0.8 gpd/ft2 Orifices
Required Primary Area 300 ft2 Total Number of Orifices -
Designed Primary Area 300 ft2 Diameter - in
Designed Reserve Area 300 ft2 Spacing - in
Trench/Bed Width 8 ft Manifold
Trench/Bed Length 37.5 ft Schedule/Class 3034
Elevation Measurements Length 6 ft
Original Drainfield Area Slope 3 % Diameter 4 in
New Slope,If Altered 3 % Preferred manifold configuration used? I 'Yes 0 No
Depth of Excavation Up-slope 24 in Transport Pipe
11 from Original Grade Dow„-slope 21 in Schedule/Class 3034
Designed Vertical Separation 36+ in Length 20 ft
Gravelless Chambers Required? ❑Yes 16 No 0 Optional Diameter 4 in
Pump Required? 0 Yes EilNo Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day -
Diff.in Elevation Between Pump&Uppermost Orifice - ft Dose quantity - gal
Drainfield Squirt Height/Selected Residual(head) - ft Chamber Capacity(flood) - gal
A
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls: Please check those required.
Capacity @ Total Pressure Head - gpm Meter 0 Event Counter
Calculated Total Pressure Head - ft im : Sp° V wI ,Pump off -
Comments FEB 1 3 2024 ,4 ,-
MASONCOUN T v ENVIRONMENTAL HEALTH
JEW
711111
DESIGN FORM—PAGE TWO Assessor's Parcel Number:2 2 0 2 1 — 5 0 -- 9 0 0 3 1
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
lti Test hole locations lilDrainfield orientation and layout Reference depth from original grade:
21 Soil logs 54 Trench/bed dimensions and g Septic tank
21 Property lines critical distances within layout 121 Drainfield cover
21 Existing and proposed wells fit D-Box/Valve box locations Reference depth from original grade
within 100 ft of property 21 Septic tank/pump chamber and restrictive strata:
0 Measurements to cuts,banks,and locations 21 Laterals,trench/bed,top and
surface water and critical areas 62! Observation port location bottom
21 Location and orientation of 1 Clean-out location 0 Curtain drain collector
curtain drain and all absorption lif Manifold placement 0 Sand augmentation
components 64 Orifice placement Other cross-section detail:
Location and dimension of 54 Lateral placement with distance l Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
RI Buildings 64 Audible/visual alarm referenced Yes No
Pi Direction of slope indicator g Scale of drawing shown on scale g 0 Design staked out
21 Waterlines0 gRecorded Notices attached
g Roads, easements,driveways, prp R p V Do 21 Waiver(s)attached
parking 0 RI Pump curve attached
North arrow and scale drawing FEB 13 2024 ❑ 21 Evaluation of failure
shown on scale bar MASON COUNTY ENVIRONMENTAL HEALTH Non-residential Wastes justification
0 El Waste
JBW ❑ RI Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer at time of installation 21 Yes 0 No
4&/6 ° 1/19/2024
Signature of ptsigner Date
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in
compliance with state and to . -site regulations:
li
4: t .
vitt e t Health Spec' listDate
CAUTION: DESIGN APP •OVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health.
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: 02—
✓ 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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lnsta`llation & 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$350.00 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. Designer not responsible for electrical permitting or other electrical specific code requirements.
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 loft upslope of drainfield areas.
12.This design is site specific and intended to meet state and county requirements that are relate t y tern components
being proposed. Any placement of proposed buildings, proposed wells or other non-related ite t ea may or
may not meet other requirements.
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13. All onsite septic systems require regular maintenance to verify satisfactory operation. Th414g owesopr or is
responsible for the continuous operation and maintenance of the system per WAC 246-272A. For opgkfT nd nan,r
information, refer to Mason County Public Health Homeowner's Manual,which should be received after inir�R4 p o
14. System owner should be cautious of landscaping around septic components. Root intrusion hEAL
can cause premature failure of the drainfield area. In addition, bushes and trees should be kept
away from lids and other septic maintenance points. ice.,,
15. Changes made at time of installation may impact designer calculations, pump sizing,and •;;
compliance w/county and state requirements. Contact designer prior to install w/any ,. •)j
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proposed variations from design. Changes may result in additional fees and permitting. i�fir!. t_'%1,
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SEPTIC DESIGNS ADDRESS: 591E BENSON LP N • I N
3083 E.MASON BENSON RD. GRAPEVIEW,WA 98546 DESIGNER: ALEX L PAYSSE r.,s
OFFICE-360-426-1803 FAX-360-427-2353 SI l[ET: NOTES SCALE NA