HomeMy WebLinkAboutSWG2024-00185 - SWG Application / Design - 5/1/2024 MASON COUNTY 415N6 H ELTON: , 0427-97 ,EXT 400
H STREET,
SHEL ON, EXT 400
S
t# BELFAIR:360-275-4467,EXT 400
Public Health & Human Services ELMA:360482-5269,EXT 400
FAX 360-427-7787
On-Site Sewage System Permit: SWG2024-00185
APPLICANT MATHISON STEPHEN A Phone:
Address: 1249 SW 132ND LN APT 1234 BURIEN,WA 98146
OWNER MATHISON STEPHEN A Phone:
Address: 1249 SW 132ND LN APT 1234 BURIEN,WA 98146
SEPTIC DESIGNER Shaun Freeman Septic Designs' Phone: 360-731-8822
Address: 6875 E Cascade Drive PORT ORCHARD, WA 98366
SEPTIC INSTALLER WILLIAM COOKSEY• Phone: 253-380-3754
Address: 720 SE Cole Rd SHELTON,WA 98584
Site Address: 273 BE Kamilche Shores Rd
Primary Parcel Number: 319115100010
Permit Description: 2-bedroom pressure system wl sand lined bed: Repair
Permit Submitted Date: 0510112024
Permit Issued Date: 05/07/2024
Issued By: David Anderson
Current Permit Fees Paid: $805.00 (additional fees may be required upon installation of a,aleml.
Permit Expiration Date: 05101/2025 (based on dale of insveali
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 backli'll of
system components.
5 Installer is responsible for obtaining Septic DesignerlEngineer installation approval prior to
backfill of system components.
6 Mason County Asbuilt Form, Record Drawing, and Installation has 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.govthealth/environmentallonsiteloss-inspection-request.php or call:
360-427.9670, extension 400.
OFFICIAL USE ONLY
MRI¢CENf6
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ON-SITE SEWAGE SYSTEM APPLICATION > A
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APPLICANT HONt ;r r
Stephen Mathison C/O Margery Ellsworth, DPOA (360) 250 3308 3 c
MAILINGADDRESS-STREET CITY STATE,VP CODE r 3
1249 SW 132nd Lane, APT 1234, Burien WA 98146-3097 = m
SITE ADDRESS-STREET CRY AP CODE m 'R
273 SE Kamilche Shores Rd, Shelton, WA 98584 i Ica
NAME OF DESIGNER PNONE O
Shaun Freeman/Shaun Freeman Septic Designs, LLC 360-731-8822 m I
CIO
NAME OF INSTALLER PRONE I�
William Orie Cooksey, Proficient Excavation, LLC 253-380-3754 < I�
PERMITTYPE(AApdom) DRINKNGNNTER SOURCE FA
n RESIDENTIAOSS FLCOMMUNItt OSS Ff COMMERCIAL OBE
6 PRIVATE INDIVIDUAL WELL 13 PRNATE TWO-PARTY WELL 02
TYPE OF VURM(piNi.) [bF PUBLIC VMTER SYSTEM
ff NEW SVTRUCTIONIUPGRADES WREPAIRIREPIACEMENT OTHER DETAILS(aek Ma apgy) []TABLE IX REPAIR I�
SUBMITTALS - r G [] SURFACING SEWAGE ®EXISTING FAILURE []SHORELINE
MO IJ W
Ln.DESIGNFORM(REOUIRED) SEPTIC DESIGN(REQUIRED) BEDROOMS LOT 8- 17 I�
i]V VER(S)(IF APPLICABLE) 2 0.56 acres x Io'
DIRECTIONS TO SITE AND SITE CONDITIONS:(ft kc gsft)
From SE Kamilche Point Rd turn south onto SE Kamilche Shores Rd and travel I�
approximately 480 yards before reaching the private driveway on the east side of SE I o
Kamilche Shores Rd
o I�
$OEMUSTBEFLAOGEO FROM MTIN ROAD ANDTESi NOLE$MUSTBEELAGEED N9M lE5T HOLENUMBERS. IO
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE INA rep.,puWNI
[]VOLUNTARY OMAINTENANCEIPUMPING I]BUILDING PERMIT QHOMESALE OCOMPL4INT 13OTHER:
INSPECTOR SOIL LOGS COMMENIGI CONDITIONS
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901LfA0EE: RECORD DRAWING AND INSTALIATNIN REPORT
V=VERY G=GRAVELLY S=SAND L-LOAM B-SILT C=CLAY E-EXTREMELY R=ROOTS REQUIRED FOR FINALAPPROVAL.
INS TOR SIGNATURE GATE APPLICATION EXPIRATION GATE APPL PROVED1138UED BY
DATE
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IS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 1W12015
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 1 9 1 1 — 5 1 -- 0 0 0 1 0
A design will be reviewed when 33 c�of each of the following are submitted:
v Completed design form that has been signed and dated. v 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 paper size: 11"X 17"
p(• PARCEL IDENTIFICATION
Permit Number: SWG 7b2H—00 l d J Designer's Name: Shaun Freeman
Stephen Mathison 360-731-8822
Applicant's Name: C/O Margery Ellsmrth,DPOA Designer's Phone Number:
Mailing Address: 1249 SW 132nd Lane,APT 1234 Designer's Address: 6875 E.Cascade Drive
Baden WA 9B146 Port orchard WA 98366
City State ZAP City Stale Zip
DESIGN PARAMETERS
Treatment Device
❑Glendon Biofilter ❑Sand Filter ❑ Mound M rSand Lined Drsinfreld ❑Recirculating Filter,Type:
❑Aerobic Unit Make/Model ❑ Disinfection Unit Make/Model Other:
Drainfield Type
❑Gravity Ef Pressure ❑Trench ❑Bed ❑Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class 40 /
Daily Flow:Operating Capacity 240 gpd Length 24 ft
Daily Flow:Design Flow 240 gpd Diameter 1.25 in
Septic Tank Capacity(working) 1,000 gal Number 3 '
Receiving Soil Type(1-6) 1 Separation 3 - 8
Receiving Soil Appl.Rate 1 — gpd/ft' Orifices
Required Primary Area 240 ft'- Total Number of Orifices 30
Designed Primary Area 240 — ft' Diameter 1/8 in
Designed Reserve Area ft- Spacing 30 in
Trench/Bed Width 10 ft Manifold
Trench/Bed Length 24 ft Schedule/Class 40
Elevation Measurements Length 5 It
Original Drainfield Area Slope —20 e/ Diameter 1.5 in
New Slope,If Altered % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-snipe 48 in Transport Pipe
from Original Grade oown-empr 20 in ScheduWClass 40
Designed Vertical Separation 12 in Length 42 ft
Gravelless Chambers Required? ❑Yes R1 No 0 Optional Diameter 2 in
Pump Required? If Yes 0 No Dosing and Pump Chamber
Pamp/Siphon Specifications Number of doses/day 8 '
Diff.in Elevation Between Pump&Uppermost Orifice 8 ft Dose quantity 30 gal
Dminfteld Squirt Height/Selected Residual(head) 5 ft Chamber Capacity(Flood) 1,250 ' gal
Uppermost Orifice Laf Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity @ Total Pressure Head 12.3 -gpm ErTimer girElapse Meter Iti(Event Counter
Calculated Total Pressure Head 18 ft If Timer: Pump on ,Pump off 3 hours
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number:3 1 9 1 1 -- 5 1 -- 0 0 0 1 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Il Test hole locations Id Drainfield orientation and layout Reference depth from original grade:
9 Soil logs F1 Trench/bed dimensions and 9 Septic tank
19 Property lines critical distances within layout IF Drainfield cover
❑ Existing and proposed wells ❑ D-Box/Valve box locations Reference depth from original grade
within 100 ft of property Ig Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts,banks,and locations IN Laterals,trenchlbed,top and
surface water and critical areas H Observation port location bottom
❑ Location and orientation of 9 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption 9 Manifold placement ❑ Sand augmentation
components H Orifice placement Other cross-section detail:
9 Location and dimension of 9 Lateral placement with distance Ig Observation pons/clem-outs
primary system and reserve area to edge of bed
g Other Information
9 Buildings
9 Audible/visual alarm referenced Yes No
❑ Direction of slope indicator pJ Scale of drawing shown on scale ❑ P1 Design staked out
9 Waterlines bar ❑ IY Recorded Notices attached
9 Roads,easements,driveways, ❑ IY Waiver(s)attached
parking (9 ❑Pump curve attached
9 North arrow and scale drawing ❑ [9 Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑Waste strength
❑ ❑Flow
DESIGN APPROVAL
The undersigned designer must b/e/r/Jon by installer at time of installation PI Yes ❑ No
J(� 4/29/2024
Signature of Designer Date
The undersigned has reviewed this desi gll,on behalf of Mason County Public Health and determined it to he in
compliance with state and local on-s reg lations:
s/A/ MAY 07 7024
Environmental Health Specia tst
O,iry�NVIRO�M
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CO&,XWW
✓ The design is stamped"Approved"by Mason County Public Health.
✓ 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: 12r72015
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