HomeMy WebLinkAboutSWG2024-00171 - SWG Application / Design - 4/24/2024 MASON COUNTY 415N6SHELTON: , 27E ON, .EXT 400
BHELTON:360427-4467,EXIT 400
4 BELFAIR:380-275446],EXT 400
Public Health & Human Services ELMA:3604825269,EXT 400
FAX:3W427-7/87
On-Site Sewage System Permit: SWG2024.00171
APPLICANT WALKER DAVID P&SANDRA G Phone: 206-571-0262
Address: PMB 605 TULALIP,WA 98271
OWNER WALKER DAVID P&SANDRA G Phone: 206-571-0262
Address: PMB 605 TULALIP,WA 98271
SEPTIC DESIGNER ERIC RUSSELL Phone: 360-789-3607
Address: 5015 N 26th St SHELTON,WA 98584
Site Address: 110 W Morrows Ln
Primary Parcel Number: 520085000006
Permit Description: New SFR-3BR Pressure
Permit Submitted Date: 04/24/2024
Permit Issued Date: 05108/2024
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $805.00 (eddl4o areas m yne mqul a uwn nswlmum ofevs4 *
Permit Expiration Date: 0510112027
(nosed on ame oflnapectbn)
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 DesignarlEngineer 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:
3604279670, extension 400.
OFFICIAL USE ONLY
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TN F YBE SCANNED AND AVAILABLE FOR PUBLIC V ON THE MASON COUNTY WEBBRE RENSEOII—IS
DESIGN FORM-PAGE ONE Assessor's Parcel Number: 5 Z O O O b O O 5q
A design will be reviewed when 33 conies of each of the following are submitted:
•Completed design form that has been signed and dated. a Scaled layout sketch,including all applicable items on checklist
"Scaled plot plan,including all applicable heirs on checklist. a Cross-section sketch,including all applicable items on checklist.
Thisform may bescanned and avanableforpubae vlswanthe Mason Coontv WsbelEa Mirimum apersiun, 11"X17"
Permit Number: SWWG Designer's Name: s�•Lw-S&ew
Applicant's Name: 344VP. W*tAf1S1-- Designer's Phone Number: 360 -IQ9 9W7
Mailing Address: ItDI5J 1%Af1${1419',PtXft Designer's Address: 50 1C- K 3-r
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City state Zip city slam Zip
Treatment Device
0 Glendon Biofilter, 13 Sand Filter ❑Mound ❑ Sand Lined Draim eld 13 Recirculating Filter,Type:
0 Aerobic Unit MakdModel 0 Disinfection Unit MAe/Model Other: ` Vq rdDAP-n E
Drainfield Type
O Gravity sure 0 Trench 0 Bed O Sub Surface Drip
Septic Tank/Drainfleld Specifications Laterals
Number of Bedrooms Schedule/Class 4-
Daily Flow:Operating Capacity Qao gpd Length VAUQS ft
Daily Flow:Design Flow gpd Diameter /,it in
Septic Tank Capacity(working) _ k200 _ gal Number 07
Receiving Soil Type(1-6) 4 Separation (10 ft
Receiving Soil Appl.Rate 0• fp gpd/fY Orifices
Required Primary Area 5vn ft' Total Number of Orifices 'aA
Designed Primary Area t�j — it Diameter 311 k, 11
Designed Reserve Area o� fta Spacing 30 in
Trench/Bed Width 3 it Manifold
Trench/Bed Length 2C.*7 ft Schedule/Class A<D
Elevation Measurements Length VAPi1Pl" II
Original Dainfteld Area Slope % Diameter l • ZS in
New Slope,If Altered -- o o Preferred manifold configuration used? 13Y. 0 No
Depth of Excavation Up-aoa• d` 11'sio .o n Transport Pipe
from Original Grade po,•.,,-rloa 31` Z!IWOrm in Schedule/Class AE
Designed Vertical Separation in Length
Gravelless Chambers Required? 0 Yes [IN.)CQptional Diameter Z in
Pump Required? )fLYes O No Dosing and Pump Chamber
Pump/Siphon Specifications Number ofdoses/day 4
DiR.in Elevation Between Pump&Uppermost Orifice b R Dose quantity 12o gal
Dminfield Squirt Height/Selected Residual(head) 2 ft Chamber Capacity(flood) _ ladp gal
Uppermost Orific7r�her O Lower t1�am Pump Shumft Pump controls:Please check those required.
Capacity B Total Pressure Head VJ I •9 gpm OElapse Meter ❑Event Counter
Calculated Total Pressure Head 12 R If Timer: Pump on`-! b Pump off Sev 'B
Comments l%jS-%AU S4- 1 NS'P�Ot.1-5d_-
( DESIGN FORM—PAGE TWO Assessor's Parcel Number: b Z D O 8 -- go — tD d o 0 fo
Permit Number: SING
sled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Test hole locations ❑ Drainfield orientation and layout Refe a depth from original grade:
Soil logs ❑ Trench/bed dimensions and Septic tank
Property lines critical distances within layout Drainfield cover
xtstin and proposed wells ❑ D-BoxNalve box locations
6 P P ose Refere a depth from original grade
DMZwithin 100 it of property ❑ Septic tank/pump chamber and r strictive strata:
easurements to cuts,banks,and locations ❑ Laterals,trench/bed,top and
/surFace water and critical areas ❑ Observation port location bottom
Location and orientation of ❑ Clean-out location ❑ Curtain drain collector
curtain drain and all absorption ❑ Manifold placement ❑ Spnd augmentation
components ❑ Orifice placement Other oss-sectiondetatl:
Location and dimension of ❑ Lateral placement with distance Observation ports/clean-outs
primary system and reserve area to edge of bed
.quildings g Other Information
❑ Audible/visual alarm referenced Yes No
erection of slope indicator ❑ Scale of drawing shown on scale ❑ sign staked out
/�''raterlines bar ❑ eco ded Notices attached
C] R�ads,easements,driveways, f rvMs)attached
/pazkin'g ❑ p curve attached
Z North arrow and scale drawing ❑ Evaluation of failure
shown on scale but Non re ntial justification
❑ rite strength
❑ Flow
DESIGN APPROVAL
The undersigned designer in t be n ti e by installer t ne of installation Yes ❑ No
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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 local on-site regulations:
Q� G� - zY
Env 1 ealth 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:
✓ 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 Coun obec Health.
An Installation Fee is required. I' R 0 V
This form maybe scanned and available for public view on the Mason County Ri;ye' Z
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