HomeMy WebLinkAboutSWG2024-00060 - SWG Application / Design - 2/21/2024 r
MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON:360-427-9670,EXT 400
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BELFAIR:360-275-4467,EXT 400
ELMA:360-482-5269,EXT 400
ysY Public Health & Human Services FAX:360-427-7787
On-Site Sewage System Permit: SWG2024-00060
APPLICANT RICK STEVENS Phone: 360-490-1013
Address: 7300 W CLOQUALLUM SHELTON, WA 98584
OWNER OGDEN ET AL JESSE DAVID & KAYLA Phone: 1.980.241.0878
KIANA
Address: MARCELLA KAY NOWACK SHELTON, WA 98584
SEPTIC DESIGNER CHRIS ELSTROTT* Phone: 360-561-5000
Address: 128 NORTH RIVER STREET MONTESANO, WA 98563
Site Address: 480 W Elson Rd
Primary Parcel Number: 419034400030
Permit Description: New ADU -2BR Gravity
Permit Submitted Date: 02/21/2024
Permit Issued Date: 03/07/2024
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $805.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 02/21/2027 (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
MASON COUNTY DATE RECEIVED: /� I a.�
al. .. COMMUNITY SERVICES AMOUNT CENED: ' RECENEDB CO Cn
Cn
N ti rs� ,• Public Health(Community Health/Environmental Health) - c
� �(cif)); .aN0 360-427-9670,ext.400 or 360.275.4487.ext 400 SWG
415 N.6th Street•Shelton,WA 98584 S W IL)� 1 - b (06 o 2
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ON-SITE SEWAGE SYSTEM APPLICATION 3
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APPLICANT PHONE m
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R/G/C (_5-7- vg/V-S _? ei - G/9b - / /_3 Z
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MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE g
73av w- c _e ga .4e.6i -4-J ,)P 4L En
SITE ADDRESS-STREET,CITY,ZIP CODE
-2..-rYJ, 7 w 4 9v s 4�' I�
NAME OF DESIGNER / PHONE
G"1�2ls , -"�sT.v/7- g� - SG/— 50o 0
NAME OF INSTALLER PHONE v I�
Cv_s7v a-/ c,•4-9,€ c._&/vS% 360 - c/90 -.o,,.? -. I
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PERMIT TYPE(select ono) DRINKING WATER SOURCE
ESIDENTIAL OSS b7COMMUNITY OSS E.COMMERCIAL OSS 57 PRIVATE INDIVIDUAL WELL 57 PRIVATE TWO-PARTY WELL Z I W
TYPE OF WORK(select one) PUBLIC WATER SYSTEM
EW CONSTRUCTION/UPGRADES ri REPAIR/REPLACEMENT OTHER DETAILS(select ell that apply) ❑ TABLE IX REPAIR
SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE CO
ffH5ESTGN FORM(REQUIRED) PTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE r I
bWAIVER(S)(IF APPLICABLE) . 6. 4J1/ 0
DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) I i
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4Sg-e-,-- vici/v/, m ,4 oq/ Sib ti 0 %,
6(/'GX to lee) 0 A,AO c 47 4Z G Gv 4J I� 1
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. I V
OFFICIAL USE ONLY BELOW THIS LINE F
UPGRADE/FAILURE SOURCE(for reporting purposes) ��
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ❑HOME SALE ['COMPLAINT ❑OTHER: RAC 07 ,
INSPECTOR SOIL LOGS COMMENTS/CONDITI• /.P..
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FEB 21 2024 ii
By 1
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.
INS TOR SIGNATURE DATE APPLICATION EXPIRATION DATE PLI ATION APPROVED/ISSUED BY DATE
TH MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12l7/2015
•
DESIGN FORM-PAGE ONE Assessor's Parcel Number: V / . 03 - 4/ y -- 0 0 0 za
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: 11 X�17"yam_e s - -a a 'pia",�. _k _Ws�,,,# y '.� .. . ., .. s ,> ct �y.N j� S g 'rx - 'E �'``'S'^1Y .. 't�'y`t" '�Y"'%c.^ �
��.p a�' r� � �� - x �� � "a�,ARCsEI."�DF,I�I �I�O�1; ��.:;;� �:�;�,.�..�;� k:� .- �-��.Y .. � ,
. �.c��".._tiMsr>a.r .2 s``..3,tf,"v'���-.•atJ'.k,'.4� .,��.,-.,�..�ui�... � !�`S
Permit Number: SWG ga2,Li - 00062D Designer's Name: C46e.'s g-e-s17.arr
Applicant's Name: -73‘SSC 0 G,o' A/ Designer's Phone Number: .FG o -S6/- So oa
Mailing Address: y8o Ai, .F1soAv /PcyA9 o Designer's Address: /Z.e N. A''vei2 57 ZI.E7-
sirEt ro v,w�9 9Cr�y l iYr 9n.v/ ki 4- f`B.T6 3
Cr State Zip City State Zt
i� v, I W�yQ aV �g v X.. )r.�¢�� ■y�y. 1j�/�, .,?�� 9� K A' y�5y3>d.X �yWr .
.1 ' " '�.. ,„s7.T Mt .., w,S X 1Ti.e i':-P.'il Pi giMI N .^ :J 41.1.e _ �iT.A -.'
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: 6R44//7-1.,
Drainfield Type
ravity 0 Pressure 0 Trench 0 Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms Schedule/Class =NF/o7 417.P s
Daily Flow: Operating Capacity Zyp gpd Length 95- ft
Daily Flow:Design Flow 2.yo gpd Diameter 'Iv/p,: in
Septic Tank Capacity(working) lip gal Number 3
Receiving Soil Type(1-6) =r Separation 7 ft
Receiving Soil Appl. Rate G. 6 gpd/ft2 Orifices
Required Primary Area S/vo ft2 Total Number of Orifices /L
Designed Primary Area yps-- ft2 Diameter in
Designed Reserve Area yos- ft2 Spacing in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length /3,r ft Sc ule/Class .4257711 3o 3 /
Elevation Measurements Length // ft
Original Drainfield Area Slope % Diameter 7 in
New Slope,If Altered % P
Depth of Excavation Up-slope /lc
�a2 in - X
/I.� Transport Pipe
from Original Grade Do -slope M a,k -7j oZ in Schedule/Class SO 3 9
Designed Vertical Separation , (.( in Length $ SS i ft
Gravelless Chambers Required'? 0 Yes 0 No gpptional Diameter ,/ in
Pump Required? 0 Yes 0 No
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
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those re fired.
Capacity @ Total Pressure Head gpm ❑Timer ; II i e • �'�.:Sat Counter
Calculated Total Pressure Head ft If Timer: Pump o ,P p ff a :C
Comments MAR 0 7 2024 ,,, '
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
DESIGN FORM—PAGE-TWO Assessor's Parcel Number: / / 9 d-3 -- V -- o D O 3 0
, Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scale Layout Sketch Cross-Section Sketch
❑ st hole locations infield orientation and layout Reference depth from original grade:
B Soil logs Trench/bed dimensions and p tic tank
mho erty lines /critl distances within layout infield cover
a-ixisting and proposed wells Q D-Box/Valve box locations Reference depth from original grade
within 100 ft of property Septic tank/pump chamber and restrictive strata:
Measurements to cuts,banks,and �_ to tions aterals,trench/bed,top and
su ace water and critical areas 19 bservation port location bottom
Location and orientation of '�C an-out location Curtain drain collector
Gu -draZn and all absorption ❑' Manifold placement Sand augmentation
components It( Orifice placement Other cross-section detail:
D Location and dimension of Lateral placement with distance 0 Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
uil rags ed Yes No
ire Lion of slope indicator p-le of drawing shown on scale 0 I J1�s gn staked out
� w�aterlines bar 0 1 kske ed Notices attached
l3-" ads, easements,driveways, ❑ ❑W" er(s)attached
parking APPR 0 E ❑ curve attached
and scale drawing1::: ❑ valuation of failure
C North arrow MAR 0 7 2024 }.
shown on scale bar on-re •I ential justification
MASON COUNTY ENVIRONMENTAL HEALTh ■ n Waste strength
JBW ■ a low
DESIGN APPROVAL
The undersigned designer must be notified installer at time of installation es ❑ No
z-2/-ay
Signature of Designer 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:
ith W .1,0 3�7-z`f
n tiR' ental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. Z
✓ 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 Date: 12/7/2015
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