HomeMy WebLinkAboutSWG2023-00491 - SWG Application / Design - 11/20/2023 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584
SHELTON: 360-427-9670,EXT 400
J h 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: SWG2023-00491
APPLICANT BONNIE MILLER Phone:
Address: 7198 WINTERBERRY PL NW SEABECK, WA 98380
OWNER BONNIE MILLER Phone:
Address: 7198 WINTERBERRY PL NW SEABECK, WA 98380
SEWAGE DESIGNER Brandon Jones - Horizon Wastewater Phone: 360-550-4277
Address: PO Box 3031 SILVERDALE, WA 98383
Site Address: 791 NE Blacksmith Dr
Primary Parcel Number: 223107990661
Permit Description: 3-bedroom pressure system w/ class B waiver
Permit Submitted Date: 11/20/2023
Permit Issued Date: 03/08/2024
Issued By: David Anderson
Current Permit Fees Paid: $525.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 12/05/2026 (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 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 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
DATE RECEIVED: � � _ � ^�� � D
"""'�°�r�. MASON COUNTY
FiCOMMUNITY SERVICES AMOUNT RECEIVED:t RECEIVED CO
\ I Public Health(Community Health/Environmental Health; C &I
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ON-SITE SEWAGE SYSTEM APPLICATION 3 x
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APPLICANT PHONE
BONNIE MILLER 3
MAILING ADDRESS-STREET,CITY,STATE,ZIP CODE
7198 WINTERBERRY PL NW SEABECK WA 98380 co
TREET,CITY,ZIP CODE
791 NE SITE DRESS-SBLACKSMITH DR BELFAIR WA 98528 I N
NAME OF DESIGNER PHONE I N
BRANDON JONES 360-550-4277
PHONE I L.!.)NAVE OF INSTALLER
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a PERMIT TYPE(select one) DRINKING WATER SOURCE O
RESIDENTIAL OSS I'COMMUNITY ass In COMMERCIAL ass El PRIVATE INDIVIDUAL WELL W PRIVATE TWO-PARTY WELL Z I
CD
a PUBLIC WATER SYSTEM r
TYPE OF WORK(select one)
NEW CONSTRUCTION/UPGRADES 5-REPAIR/REPLACEMENT OTHER DETAILS(select all that apply/ ❑TABLE IX REPAIR
0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE co
SUBMITTALS
DESIGN FORM(REQUIRED) W SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE p I \.D
W WAIVER(S)(IF APPLICABLE) 3 1.35 ACRES 0
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex locked gate)
FROM ELFENDAHL PASS, TURN LEFT ONTO NE BEAR CREEK DEWATTO RD. TURN I o
LEFT ONTO NE BLACKSMITH DR. PROPERTY ON LEFT IN APPROXIMATELY .8 I
MILES.
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I SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS.
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OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE((or reporting purposes)
❑VOLUNTARY ❑MAINTENANCE/PUMPING ❑BUILDING PERMIT ['HOME SALE ['COMPLAINT ❑OTHER:
INSPECTOR SOIL LOGS OMMENTS!CONDITION ^
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'INSPECTOR SIG TURE DATE APPLICATION EXPIRATION DATE
APPLICA ON APPROVED/ISSUED BY DATE
/1"Z1C111) 11(05/Z026 W/ iLl
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE
REVISED 1277/2015
,
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 3 1 0 -- 7 9 -- 9 0 6 6 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..Ilaximum paper size: 11"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG 10 23-oo(i Q/ Designer's Name: BRANDON JONES
Applicant's Name: BONNIE MILLER Designer's Phone Number: 360-550�277
Mailing Address: 7198 WINTERBERRY PL NW Designer's Address: PO BOX 3031
SEABECK WA 98380 SILVERDALE WA 98383
City State Zip City State Zip
DESIGN PARAMETERS
Treatment Device - 4jZ„
❑Glendon Biofilter 0 Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type: Fes �//
❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: ,3 20'
.�OF Drainfield Type RECF/Vtca
D Gravity 6G Pressure I 'Trench 0 Bed 0 Sub Sur .. grip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 " Schedule/Class SCH-40 c
Daily Flow:Operating Capacity ,270 - gpd Length 50 ft
Daily Flow:Design Flow 360 gpd Diameter 1 in
i
Septic Tank Capacity(working) 1200 gal Number 4
Receiving Soil Type(1-6) 4 Separation 5 (O/C) - ft
Receiving Soil Appl.Rate .6 gpd/ft2 Orifices
Required Primary Area 600 ft2 Total Number of Orifices 68
Designed Primary Area 600 -- ft2 Diameter 1/8 in
Designed Reserve Area 900 ' ft2 Spacing 36 in
Trench/Bed Width 3 - ft Manifold
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Trench/Bed Length 50 - ft Schedule/Class SCH-40
Elevation Measurements Length 5' ft
Original Drainfield Area Slope 5-10 % Diameter 2 in
New Slope,If Altered N/A % Preferred manifold configuration used? IX Yes 0 No
Depth of Excavation Up-slope 13 in Transport Pipe
from Original Grade Down-slope 10 in Schedule/Class SCH-40
Designed Vertical Separation 12 e- in Length 50 ft
Gravelless Chambers Required? 0 Yes 0 No LR'Optional Diameter 2 in
Pump Required? Ef Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day 8 (MIN)
Diff.in Elevation Between Pump&Uppermost Orifice 6 ft Dose quantity 30 gal
Drainfield Squirt Height/Selected Residual(head) 5 ft Chamber Capacity(flood) 1,200 gal
Uppermost Orifice lit Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 30 gpm ErTimer IIi1$lapse Meter ®'Event Counter
Calculated Total Pressure Head 26 ft If Timer: Pump on 1 M ,Pump off 3H
li Comments
TIMER TO BE SET AFTER FIELD TESTING PUMP PERFORMANCE. APPROVED
MAR 0 8 2024
MASON COUNTY ENVIRONMENTAL HEALTH
DJA
Amminffinmino.
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 2 3 1 0 -- 7 9 -- 9 0 6 6 1
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Lot Test hole locations 10 Drainfield orientation and layout Reference depth from original grade:
Lot Soil logs 0 Trench/bed dimensions and er Septic tank
O Property lines critical distances within layout ® Drainfield cover
O Existingand proposed wells g D-BoxNalve box locations
P P Reference depth from original grade
within 100 ft of property 10 Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts,banks,and locations 10 Laterals,trench bed,top and
surface water and critical areas 0 Observation port location bottom
❑ Location and orientation of 0 Clean-out location 0 Curtain drain collector
curtain drain and all absorption 0 Manifold placement 0 Sand augmentation
components 0 Orifice placement Other cross-section detail:
O Location and dimension of 0 Lateral placement with distance 0 Observation ports/clean-outs
primary system and reserve area to edge of bed
Buildings g Other Information
0 Lot Audible/visual alarm referenced Yes No
O Direction of slope indicator 0 Scale of drawing shown on scale 0 Er Design staked out
O Waterlines bar Lot 0 Recorded Notices attached
P1 Roads, easements,driveways, Lot 0 Waiver(s)attached
parking 0 0 Pump curve attached
O North arrow and scale drawing 0 0 Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑ Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer at time of installation Er Yes ❑ No
2/13/2024
Signature of Designer Date
The undersigned has reviewed this design on behalf of Mason County Public Health and dejirtned it to be in
compliance with state and local on-site r lations: V P J O VE D
3 4/70Z1-/
Environmental Health Specialist Date MAR 8 2024
r
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOW! Mktii 9 Yl'ApNMENTAL HEAL'N
✓ The design is stamped"Approved"by Mason County Public Health. Z�oS� Q,j(� .
V The Onsite Sewage Permit has not expired,the Permit Expiration Date is: I
✓ 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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