HomeMy WebLinkAboutSWG2024-00018 - SWG Application / Design - 1/17/2024 • rf MASON COUNTY 415N 6SHELTON: 60427-O70,EXT 664
r 'VIH 'V SH STREET,
SHETON, EXT 400
BELFAIR 360-2754467,EXT 400
Public Health & Human Services ELMA:360.482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2024-00018
APPLICANT MOYE STEVEN E&MICHELLE V Phone:
Address: 13019 LAKE KATHLEEN RD SE RENTON,WA 98059
OWNER MOVE STEVEN E&MICHELLE V Phone:
Address: 13019 LAKE KATHLEEN RD SE RENTON,WA 98059
SEPTIC DESIGNER ROD LEFT-Acme Design Phone: 360-698-8488
Address: PO Box 2954 SILVERDALE,WA 98383
Site Address: 1370 NE Collins Lake Dr
Primary Parcel Number: 223315100023
Permit Description: New SFR-3BR Gravity w/class b waiver
Permit Submitted Date: 01/17/2024
Permit Issued Date: 04/11/2024
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $540.00 (additional fees may oe re9mred aFoo msfeifedon or system).
Permit Expiration Date: 02/08/2027 (WsW m aare or m,modon)
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 Asbuilf Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF Des
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/healthlonvironmentallonsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
OFFICIAL USE ONLY
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DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 3 3 1 — 5 1 — 0 0 0 2 3
A design will be reviewed when 33 c�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 maybe scanned and available for public view on the Mason County Web site.Maximum pope✓size 11"X 17
PARCEL IDENTIFICATION
Perrnit Number: SWG Designer's Name: ROD LEFT
Applicant's Name: STEVE MOPE Designer's Phone Number: 360-698-9488
Mailing Address: 13D19 LAKE KATHLEEN RD SE Designer's Address: P.O.BOX E &t
RE ON WA 98059 SILVERDALE WA 98383
City State Zip City State Zip
DESIGNYARAMIRTERS
Treatment Device
❑Glendon Bimilter ❑Said Fdwe ❑Mound ❑Send Lined Dminfield ❑Recimulating Filter,Type:
❑Aerobic Ihdt MakHModel ❑Disinfection Unit Mekr/Modal Other:
Drainfield Type
Et Gravity ❑Pressure ❑Trench ❑Bed ❑Sub Surface Drip
Septic Tank/Drainfleld Specifications Laterals
Number of Bedrooms 5 Scbedule/Class 40
Daily Flow:Operating Capacity _ NSO Slid Length 67 It
Daily Flow.Design Flow 600 glad Diameter 4 in
Septic Tank Capacity 1500 gal Number 5
Receiving Soil Type(1-6) 4 Separation 5 ft
Receiving Soil AppL Rate .6 gpd/ft' Orifices
Required Primary Area 1000 ft Total Number of Orifices NA
Designed Primary Area 1000 ft Diameter NA in
Designed Reserve Area 1000 ft2 Spacing NA in
TmnchBed Width 3 It Manifold
Trench/Bed Length 335 ft Schedule/Class NA
Elevation Measurements Length NA ft
Original Dminfield Area Slope 5 % Diameter NA M
New Slope,If Altered 5 % Preferred manifold configuration used? 0 Yes [7 No
Depth of Excavation Upslopc 16 in Transport Pipe
from Original Grade Dawn-no, 14 in Schedule/Class 40
Designed Vertical Separation 18 in Length 40 it
Gravellas Chambers Required? ❑Yes id No O Optional Diameter 4 in _
Pump Required? ❑Yes EfNo Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day NA
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity NA gal
Orifice N^ ft Chamber Capacity NA gal
Uppermost Orifice[7 Higher 0 Lower than Pump Shutoff Pump controls:Please check those required-
Capacity Q Total Pressure Head NA Spin [Tuner ❑Elapse Meter ❑Event Counter
Calculated Total Pressure Head NA R If Tither: Pump on .Pump off
Co®nenk
PPROVE
APR 1 1 2024 Lf
MASON COUNTY ENVIRONMENTAL HEALTH
JBW
DESIGN FORM—PAGE TWO Assessor's Parcel Number:2 2 3 3 1 — 5 1 — 0 0 0 2 3
Pemmt Number SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
A Test hole locations 19 Drainfield orientation and layout Reference depth from original grade:
m Soil logs Ed Trench/bed dimensions and Rf Septic tank
It Property lines critical distances within layout 19 Ihamfield cover
61 Existing and proposed wells Rf D-Box/Valve box locations Reference depth from original grade
within 100 ft of property E6 Septic tank/pump chamber and restrictive strata:
m Measurements to cuts,banks,and locations Z Laterals,trenchlbed,top and
surface water and critical areas ig Observation port location bottom
❑ Location and orientation of 96 Cleanaut location ❑ Curtain drain collector
curtain drain and all absorption 51 Manifold placement ❑ Sand augmentation
components ❑ Orifice placement Other cross-section detail:
m Location and dimension of R1 Lateral placement with distance 19 Observation ports/clean-outs
primary system and reserve area to edge of bed Other Information
m Buildings ❑ Audible/visual alarm referenced Yes No
It Direction of slope indicator 66 Scale of drawing shown on scale ❑ PJ Design staked out
m Waterlines bar ❑ 6f Recorded Notices attached
id Roads,easements,driveways, if ❑Waiver(s)attached
parking ❑ E9 Pump curve attached
16 North arrow and scale drawing ❑ 19 Evaluation of failure
shown on scale bar Non-residential justification
❑ Eg,�/Waste strength
❑ Ed Flow
DFSIGNAPPROVAL"
The undersigned designer must be notified by my?er at time of ins Us on VYes ❑ No
// / /2 - � avak
Si o 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 o r regulations:
k WId �_�1j Y
Env" • taI I th Specialist Date
CAUTION: DESIGN APPRO AL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
J The design is stamped"Approved"by Mason county Public Health. Q�
J The C usite Sewage Permit has not expired,the Permit Expiation Date is:
J Drainfreld 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: 12/72015
Mason County WA GIS Web Map
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