HomeMy WebLinkAboutSWG2024-00165 - SWG Application / Design - 4/23/2024 MASON COUNTY 415N 6SHELTON:STREET,SHELTON,
70,EXT 664
SHELTON:360d27-9467.EXT 400
BELFAIR'
ELMA.360-275-0467,EXT 400
Public Health & Human Services ELnw:360ie2s269,Exr boa
4 FAX:360427-T/87
On-Site Sewage System Permit: SWG2024-00165
APPLICANT ROBERTS KAREN Phone:
Address: 90 W KINGFISHER LN SHELTON,WA 98584
OWNER ROBr:RTS KAREN Phone:
Address: 90 V. KINGFISHER LN SHELTON,WA 98584
SEPTIC DESIGNER ADAM HUNTER* Phone: 360-753-1226
Address: PO Box 162 OLYMPIA,WA 98507
Site Address: 90 W Kingfisher Ln
Primary Parcel Number. 320312190030
Permit Description: Replacement 3BR GLendon
Permit Submitted Date: 04/23/2024
Permit Issued Date: 05/09/2024
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $540.00 (addItional fees may bo reamred upon nstalld0on of srscem).
Permit Expiration Date: 04/23/2027 (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 Drainffeld 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 DesigneNEngtneer 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/heahhlenvimnmentallonsiteloss-inspection-mquest.php or call:
360427-9670,extension 400.
OFFICIAL USE ONLY
MASON COUNTY PUBLIC HEALTH MRMCB FD.
ONSITESEWAGL SYSTEM APPLICATION MDDNRlC .G REGNE
415N5th5DeeZ,(Bldg8) SheltonWA98584 \J 0 N
Shelton:BWiD 9678 eXt400 BeIfaiR 360275i987 ext 400 SWG �� _G6 � /_L 0 �
YY w ll Sp�] 2 �
ARPUCMIT PHONE y D
KAREN ROBERTS 3604278976 m
MAILING ADDRESS-STREET CITY.STATE.LP CODE r
90 W KINGFISHER LN - SHELTON WA 98584 c
3
SITEADpVESS-9LRFET LT',LP LODE W
90 W KINGFISHER LN SHELTON WA 98584 m
NAW OF DESIGNER PHONE Ir ,
ADAM HUNTER 3607531226
INME OF INSTALLER PHONE
TBD
CHECKALLAPPLILABLEREMS DRINKING WATER SOURCE 0
0 NEW CONSTRUCTION 0 RVHOLDINGTANKONLY 0 PRIVATE INDIVIDUALWELL
REPLACEMENT SYSTEM O INSTALLATICNPERMa CINLY PRWATETWCFPARTYWELL S
0 TABLE 9 REPAIR 0 SINGLE FAMILY 0 COMMUNITYIDUBLICWATERSYSTEM
TANK(S)ONLV 0 COMMERCIAL SYSTEM NAME: oI
O UPGRADE TO EXISTING 0 OTHER: B,,,,,MS LOTSRE I�
0 EXISTING FAILURE 'R,rorNOnnir19nWIRx 3 25.43 W
ar,xm,Nwwo,- r
DIRECTIONS TO SITE-SE SPEEFICANDADVISECFANV NEEDED INFORW4 ION FORACCESS IeiL KKw 9Me) 0
IF P
0 I�
SIEPWSTREFLAGGEDFROUM ROWANp TEBTMWE9YU8i BERJBOEU WTTN TESTNOLENUNBERS I 'v
OFFICIAL USE ONLY BELOW THIS LINE
UPGRPCET FAILURE SOURCE(M'n gWWA )
DVOLUNTARY E3WINTENANCEIPUMPING DBUILDINGPERMIT OHCMESALE DCOMPLNNT DOTHER:
INSPECTORWLLOGS COMMENTSICONDIN:NS )D
SOILCOOFB:
V=VERY O+OR4VELLY 5-9AN0 L•LOAM y•BILT C+CtAY E•E1t1REMELV R-ROOTS
ST ECTOR SIGNATURE W1E MRIC TION EXPIRATION d1TE LICATIXI APPROVED BV M1E
MY BE SCAINEDAND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBU Uki REWSED IWQDU
DESIGN FORM—PAGE ONE Assessor's Parcel Number.3,2&�L i�,l — ISL
A design will be reviewed when 3 copies of each of the following are submitted:
J 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 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 IT'
PARCEL IDENTIFICATION
Permit Number: SWG -2G — (9f1� (is Designer's Name: ADAM HUNTER
Applicant's Name: KAREN ROBERTS Designer's Phone Number: 360-753-1226
Mailing Address: 90 W KINGFISHER LN Designer's Address: PO BOX 162
SHELTON WA 96564 OLYMPIA WA 95507
City State zip city State zip
Treatment Device
fia(Gleadou Biofilter ❑Sand Filter ❑Mound ❑Sand Lined Dminfield 0 Recirculating Filter,Type:
❑Aerobic Unit Make/Model ❑Disinfection Unit Make/Model Other:
Drainfield Type
❑Gravity ❑Pressure ❑Trench ❑Bed ❑Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class PER GLENDON
Daily Flow:Operating Capacity 270 gpd Length PER GLENDON It
Daily Flow:Design Flow 360 gpd Diameter PER GLENDON in
Septic Tank Capacity 1200(EXISTING) gal Number PER GLENDON
Receiving Soil Type(1-6) 5 Separation PER GLENDON ft
Receiving Soil Appl.Rate 0.4 gpd/f12 Orifices
Required Primary Area 9W ft2 Total Number of Orifices PER GLENDON
Designed Primary Area 900 f12 Diameter PER GLENDON
in
Designed Reserve Area 900 ft2 Spacing PER GLENDON in
Trench/Bed Width PER GLENDON ft Manifold
Trench/Bed Length PER GLENDON ft Schedule/Class 40
Elevation Measurements Length 60 ft
Original Drainfield Area Slope 0 / Diameter 1 in
New Slope,If Altered 0 /o Preferred manifold configuration used? 1YYes ❑No
Depth of Excavation U"Iopc PER GLENDON ill Transport Pipe
from Original Grade Down-slops PER GLENDON in Schedule/Class 40
Designed Vertical Separation >12 in Length 30 ft
Gravelless Chambers Required? ❑Yes t2fNo D Optional Diameter 1 in
Pump Required? Sf Yes 17 No Dosing and Pump Chamber
Pump/Siphon Specifications Number ofdoses/day PER GLENDON
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity PER GLENDON gal
Orifice ft Chamber.Capacity 1200 gal
Uppermost Orifice EdHigher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity Q Total Pressure Head PER GLENDON gpm drimer �ui�r V of Counter
E W P6mifo
Calculated Total Pressure Head PER GLENDON ft If Timer: Pump R Ll NDON
Comments 202)f
MASON COUNTY ENVIRONMENTAL NEALTR
JBW
DESIGN FORM—PAGE TWO Assessor's Parcel Number: aQ a L -- a_� -- _Q L L:L
Permit Number: SING
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
1f Test hole locations 11 Drainfield orientation and layout Reference depth from original grade:
9 Soil logs 19 Trench/bed dimensions and ld Septic tank
E9 Property lines critical distances within layout 17 Drainfield cover
Existing and proposed wells D-Box/Valve box locations Reference depth from original grade
within 100 ft of property E9 Septic tank/pump chamber and restrictive strata:
EZ Measurements to cuts,banks,and locations ❑ Laterals,trench/bed,top and
surface water and critical areas V Observation port location bottom
Eff Location and orientation of 9 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption Id Manifold placement ❑ Sand augmentation
components EZ Orifice placement Other cross-section detail:
9 Location and dimension of Ed Lateral placement with distance Ef Observation ports/cleanouts
primary system and reserve area to edge of bed
f� Buildings Other Information
Audible/visual alarm referenced Yes No
V Direction of slope indicator 9 Scale of drawingshown on scale Ed ❑ Design staked out
Ef Waterlines bar ❑ ❑ Recorded Notices attached
Rf Roads,easements,driveways, p p R 0 V E ❑❑ ❑Waiver(s)attached
parking ❑ Pump curve attached
9 North arrow and scale drawing ❑ ❑ Evaluation of failure
shown on scale barMAY 0 9 ZV4 Non-residential justification
MASON COUNTY ENVIRONMENTAL HEALTH ❑ ❑Waste strength
JBVVd ❑ ❑ Flow
DESI APPROVAL
The undersigned designer mus be no cd b •taller at time of installation E Yes ❑ No
4/22/24
Si �f Designer Date
The undersigned has reviewed this d ,ign on behalf of Mason County Public Health and determined itto be in
compliance with state and local o(/"t/o,,regulations: y
\RA{i-i W.(� 7!— q- Z 1
E it 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: 7�27
Drainfield site conditions have not been altered to adversely affect conditions of design appT ro
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 Daze: 12/7/2015
i
P PAGE 1
MASON COUNTY HEALTH DEPARTMENT
ON-SITE SEWAGE DISPOSAL SYSTEM DESIGN
SITE#: PARCEL M 320312190030
DATE SUBMITTED: 4/22/2024 LEGAULOT M LOT 3 OF
SP#3018
SUBMITTED BY: ADAM HUNTER
APPLICANT: KAREN ROBERTS
ADDRESS:
I.CALCULATIONS
NUMBER OF BEDROOMS= 3
RESIDENTIAL GPD FLOW= 360
IF NON-RESIDENTIAL-GPD FLOW
WILL BE AS FOLLOWS:
GPD=
APPLICATION RATE= 0.4 GPD/FT2
REDUCTION=LEAVE BLANK IF NO REDUCTION TAKEN
DRAINFIELD SIZING
ABSORPTION AREA= 900 FT2
TRENCH LENGTH OR BED CONFIG.= PER GLENDON
II.WATERPROOF SEPTIC TANK
COMPOSITION AND SIZE= 1200GAL
NEW OR EXISTING= EXISTING
Ill.DRAINFIELD CROSS SECTION
DEPTH TO DRAINROCK BOTTOM= N/A
ROCK DEPTH BELOW PIPE= N/A
SEPARATION FROM TRENCH BOTTOM TO IMPERMEABLE
MATERIAUSEASONAL SATURATION= N/A
FILL DEPTH= NIA
TRENCH WIDTH= NIA
APPROVE `
4/12/24 MAY 0 9 2024
^., MASON COUNTY ENVIRONMENTAL kE 0a
t. JBW
MYM[q
24
00000 000
-
O
3: m z 111 y °A
m m p
i K p m y 8 m
s a
-r--
- m x n i - r
Dv o m v e m o ,11
g Z r
1 �
Am 6� g m
9 N
A K
mm 818.84
A
4 m F u
m 683!
O
i / m �i�• 8
D
m 1614 n
m c n
z $ m _
� I ' D
' l V O
� O
aT IZII p / �' _ � 9.' _ b1
1 m
l _
o r ---------- - I � —
m --------
---Am
1W53553��V//ALlll/l
5 O c
O i0 O m
z m
rn 'D
m
T w
t4. s
i
J
e
1
co
to
f
A � E
Q
N C
a am Q'Qi 7
m
iig � i m
N 8 ER a n m $ m
K yypp
2 Ozz
p D ^�� F C
m m '3f2
I
p T= 20 Om
OY 1n
F �0 , $ Iy (D
n z yo �Fq O zw Fey'
o sum o amp
o v As
L] K �l s = � v
a z o
T A a $ " �" I 5 g � 7 Fi a
mv .8m
z m ■■ 'g ° p A m 2 z. $ F
i 9
y
p x@
A
m &y m