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HomeMy WebLinkAboutSWG2024-00016 - SWG Application / Design - 1/12/2024 MASON COUNTY 415 N 6TH STREET,SHELTON,WA 98584 SHELTON:360-427-9670,EXT 400 J L BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT400 FAX:360-427-7787 On-Site Sewage System Permit: SWG2024-00016 APPLICANT MIELKE SUMMER ROSE Phone: Address: 51 E GOLDFINCH LN BELFAIR, WA 98528 OWNER MIELKE SUMMER ROSE Phone: Address: 51 E GOLDFINCH LN BELFAIR, WA 98528 SEPTIC DESIGNER ROD LEFT* Phone: 360-698-8488 Address: PO BOX 2954 SILVERDALE, WA 98383 Site Address: 250 E Johnson Ridge Dr Primary Parcel Number: 222137700050 Permit Description: New SFR-3BR Gravity w/class b waiver Permit Submitted Date: 01/12/2024 Permit Issued Date: 03/11/2024 Issued By: Jeff Wilmoth Current Permit Fees Paid: $540.00 (additional fees may be required upon installation of system). Permit Expiration Date: 02/08/2027 (based on date of inspection) Permit Conditions: 1 Proposed development subject to zoning requirements and approval by the planning department staff per Mason County Title 17. 2 Permit must be installed by a Mason County Certified Installer unless prior written authorization from Mason County is obtained. 3 Drain field installation not to exceed designed upslope and downslope depth specified on design form. 4 Installer is responsible for obtaining Mason County installation approval prior to backfill of system components. 5 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to backfill of system components. 6 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for final installation approval. THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS. PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS. THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED. FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES. For Final Inspection visit: masoncountywa.gov/health/environmental/onsite/oss-inspection-request.php or call: 360-427-9670, extension 400. a till amimmumim. OFFICIAL USE ONLY— raLRJ =r MASON COUNTY DATEaK�t�D I " ( l - ��. ' 6 2024 COMMUNITY SERVICES AMOUNT RECEIVED.. 1111 ='EIVED -._ - KW, - - Public Health(Community Health/Environmental Health) < w 41$N.be S0.est l-9 ltn.WA 98584 ext 400 SWG 0 — )/ _ O I ' O x - 61$N.b[n$Meet Shelton.WA 98584 \`�\/ Z '17J ON-SITE SEWAGE SYSTEM APPLICATION › 33 m m APPLICANT PHONE m Summer Mielke & Jesse Werdall 360-801 -3633 z MAILING ADDRESS-STREET.CITY.STATE.ZIP CODE g 51 E. Goldfinch Lane �� 3 Belfair WA 98528 CO SITE ADDRESS-STREET.CITY.ZIP CODE ,J IA ` 73 150 E. Johnson Ridge Dr Belfair WA 98528 I I" NAME OF DESIGNER PHONE IV Rod Left 360-698-8488 NAME OF INSTALLER PHONE 0 N C PERMIT TYPE(seled one) DRINKING WATER SOURCE O C gRESIDENTIAL OSS I':COMMUNITY OSS ��L'.COMMERCIAL OSS U.PRIVATE INDIVIDUAL WELL U)PRIVATE TWO-PARTY WELL Z CO TYPE OF WORK(select one) V PUBLIC WATER SYSTEM - 1 a NEW CONSTRUCTION/UPGRADES E REPAIR I REPLACEMENT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR J SUBMITTALS 0 SURFACING SEWAGE 0 EXISTING FAILURE 0 SHORELINE FTDESIGN FORM(REQUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT SIZE W I J 542sq(-*- ' gWAIVER(S)(IF APPLICABLE) 3 219, ° IQ DIRECTIONS TO SITE AND SITE CONDITIONS:(ex.locked gate) See map I o O Io joi SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WW1 l TEST HOLE NUMBERS. I O -- OFFICIAL USE ONLY BELOW THIS LINE UPGRADE/FAILURE SOURCE(for reporting purposes) ❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT El HOME SALE ❑COMPLAINT ElOTHER: INSPECTOR SOIL LOGS / /� COMMENTS!CONDITIONS1 V _ �\/L Gy�yre 3C) V o- L icapers? a(i2/2_, G—toy, Z t)1,r uo""i� y '2,5—� 11 RECORD DRAWING AND INSTALLATION REPORT SOIL CODES: V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL. iySPE OR SIGNATURE DATE APPLICATION EXPIRATION DATE APP ION APPROVED/ISSLED BY DATE 1. _,2-2 T S AY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE 7 REVISED 12/7/2015 ' DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 2 1 3 — 7 7 — 0 0 0 5 0 A design will be reviewed when 3 copies of each of the following are submitted: '"Completed design form that has been signed and dated. 'I 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" `'�. '" V0 pAl2( aIDIIN3TFTCATIJCO.:' Permit Number: SWG C)2"/ '-(DO l(o Designer's Name: Rod Left Applicant's Name: Summer Mielke& esse Werdall Designer's Phone Number: (360)698 8488 Mailing Address: 51 E Goldfinch Ln Designer's Address: P.O.Box 2954 Belfair WA 98528 Silverdale WA 98383 City State Zip City State Zip rnv 't`4 'ay,� ':a.Yrr a +Y M t.v-. Treatment Device 0 Glendon Biofilter ❑Sand Filter 0 Mound 0 Sand Lined Drainfield 0 Recirculating Filter,Type: ❑Aerobic Unit Make/Model 0 Disinfection Unit Make/Model Other: Drainfield Type gGravity 0 Pressure Nnt Trench ❑Bed 0 Sub Surface Drip Septic Tank/Drainfield Specifications Laterals Number of Bedrooms 3 Schedule/Class 40 Daily Flow:Operating Capacity a7 b gpd Length SO ft Daily Flow:Design Flow 360 gpd Diameter 4 in Septic Tank Capacity _ 1Z-50 gal Number 1-} Receiving Soil Type(1-6) 4 Separation 5 ft Receiving Soil Appl.Rate 0.6 gpd/ft2 Orifices Required Primary Area 600 ft2 Total Number of Orifices N/A Designed Primary Area 600 ft2 Diameter N/A in Designed Reserve Area 600 ft2 Spacing N/A in Trench/Bed Width 3 ft Manifold Trench/Bed Length 200 ft Schedule/Class N/A Elevation Measurements Length N/A ft Original Drainfield Area Slope 5-8 % Diameter N/A in New Slope,If Altered 5-8 % Preferred manifold configuration used? El 0 No Depth of Excavation Up-slope 10 in Transport Pipe from Original Grade Down-slope 8 in Schedule/Class 40 Designed Vertical Separation 18 in Length 50 ft Gravelless Chambers Required? 0 Yes 0 No lr 'Optional Diameter 4 in Pump Required? 0 Yes ElNo Dosing and Pump Chamber Pump/Siphon Specifications Number of doses/day N/A Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity N/A gal Orifice N/A ft Chamber Capacity N/A gal Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required. Capacity @ Total Pressure Head gpm ❑Timer ❑Elapse Meter 0 Event Counter Calculated Total Pressure Head ft If Timer: Pump on ,Pump off Comments APPROVEA MQlj � l�,.l MAR 1 1 2024 MASON COUNTY ENVIRONMENTAL HEALTH► J8w MASON COUNTY ENVIRONMENTAL HEALTH A JBW DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 2 2 1 3 -- 7 7 — 0 0 0 5 0 Permit Number: SWG DESIGN CHECKLISTS Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch 66 Test hole locations Pi Drainfield orientation and layout Reference depth from original grade: g Soil logs g Trench/bed dimensions and g Septic tank Property lines critical distances within layout 12f Drainfield cover RI Existing and proposed wells RI D-Box/Valve box locations Reference depth from original grade within 100 ft of property RI Septic tank/pump chamber and restrictive strata: ❑ Measurements to cuts,banks,and locations 121 Laterals,trench/bed,top and surface water and critical areas Eil Observation port location bottom ❑ Location and orientation of RI Clean-out location ❑ Curtain drain collector curtain drain and all absorption 0 Manifold placement 0 Sand augmentation components 0 Orifice placement Other cross-section detail: Eil Location and dimension of g Lateral placement with distance 12( Observation ports/clean-outs primary system and reserve area to edge of bed g Other Information RI Buildings 0 Audible/visual alarm referenced Yes No • Direction of slope indicator El Scale of drawing shown on scale 0 g Design staked out RI Waterlines bar 0 RI Recorded Notices attached RI Roads,easements,driveways, lI 0 Waiver(s)attached parking 0 RI Pump curve attached 6I North arrow and scale drawing 0 R Evaluation of failure shown on scale bar Non-residential justification ❑ RI Waste strength O CI Flow DESIGN APPROVAL The undersigned designer must be notified by ' t time of- tallation g Yes ❑ No � fo Tao Zozq Si a 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 local ite regulations: fA A/1/4;3——, local �••••ental Health Specialist Date CAUTION: DESIGN APPROVAL 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: 2-DG- / ✓ 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. 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