HomeMy WebLinkAboutSWG2024-00214 - SWG Application / Design - 5/16/2024 584
® MASON COUNTY 415N6SHELTON ,SHELTO7 ,EXT 400
SHELFAIR 360-275A4]0,EXT 400
BELFAIR.360-2]5446],EXT 400
Public Health & Human Services ELMA.360482-5269.EXT 400
FAX 360427-7787
On-Site Sewage System Permit: SWG2024-00214
APPLICANT BRERETON SARAH &AUSTIN Phone.
Address: 25381 N US HWY 101 HOODSPORT, WA 98548
OWNER BRERETON SARAH &AUSTIN Phone:
Address: 25381 N US HWY 101 HOODSPORT, WA 98548
SEPTIC DESIGNER DALE TAHJA-Septic Designer Phone: 360426-5940
Address: 2450 W DEEGAN ROAD WEST SHELTON,WA 98584
Site Address. 51 E Galliano Dr
Primary Parcel Number: 322325021006
Permit Description: New SFR-4BR Gravity
Permit Submitted Date: 05/16/2024
Permit Issued Date: 06/18/2024
Issued By Jeff Wilmoth
Current Permit Fees Paid: $805.00 (additional fees may be required upon appellation of oysiem(.
Permit Expiration Date: 06/12/2027 (based oa dace af,aa,dloo)
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 back ill 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/oss4nspection4equest.php or call:
360-427-9670, extension 400.
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OFFICIAL USE ONLY
MASON COUNTY CAR MRFEVE1
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COMMUNITY SERVICES Go w
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ON-SITE SEWAGE SYSTEM APPLICATION 3 A
APPLICANT PHONE m m
Austin Brereton (801) 850-7869 c
MAI LI NO ADD R ESS-STREET CITY STATE,LP CODE m
25381 N. US Hwy 101 Hoodsport WA 98548 p
SITEACORE65-STREET CITY ZIP LODE
E. Galliano Dr. Union WA 98592 CO
NAME OF DESIGNER PHONE I N
Dale L. Tahja (360) 426-5940
NAME OF INSTALLER PHONE v I N
PERMIT TYPE M MA,wMJ DRINNNG WATER SOURCE W
[RESIDENTIALOW EL7COMMUNITYOSS IrHDOMMERCIALOSS ffPRIVATEINDMOUALWELL 61PRIVATETWPPARTYWYLL Z IN
TYPE GE WORN ON.-1 V,PUBLIC WATER SYSTEM PUD41 I
ff NEW CONSTRUCTION I UPGRADES EFREPAIRiREPIFACEMEN7 OTHER DETAILS React 0 Mai aNMS ❑TABLE IX REPAIR I Ql
MLIEpSITTALS ❑SURFACING SEWAGE ❑ERISTING FAILURE ❑SHORELINE
9pDESIGN FORM(REQUIRED) VSEPTIC DESIGN(REQUIRED) BEDROOMS LOT SUE r0
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N(AIVER(S)(IF APPLICABLE) 4 0.56 acre x
DIRECTIONS TO SITEAND SITE CONLRIONS'.* NxAMiNMA N
Take McReavy Rd. into Union, left on 5th St., right on 3rd St., left on 4ZSt., on Galliano j
Dr, first lot to the left, ro I o
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OFFICIAL USE ONLY BELOW THIS LINE --
UPGRADE I FAILURE SOURCE MY MEARM W,%aaa)
❑VOLUNTARY ❑MAINTENANCE/PUMPING 0BUILDINGPERMIT 0HOMESALE OCOMPUINT ❑OTHER:
INSPECTOR SOIL LOGS NE TONS
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SpLC00E5: VI RECORD DRAWINGAND INSTALLATION REPORT
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=VERY G=GRAVELLY 5= D -LOAM 61=SILT L=CL1V E=EXTflEMELY ' ROOTS REQUIRED FOR FINALAFNiOVpL,
$PE T 'SIGNATURE DATE APPLICATION UPIRATION DATE APPNCA ON APPROVES ISSUED BY DATE
G-2 Z i2 -21 W IIA4)t
T F YBE SCANNED ANDAVIIILANL FORPUBLWVIEWONTHEIMSONCWNTYWENITE REVIGF.I.U15
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 2 3 2 — 5 0 — 2 1 0 0 6
A design will be reviewed when 3 co vies 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 items on checklist. v Cross-section sketch,including all applicable items on checklist.
This form may bwnred and avnllabfar ublle vl.on me Masn Coa W .Maxmm er siz /f"X/7"
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Permit Number: SWGOOokaN Designer's Name: Dale Tahja
Applicant's Name: Austin Brareton Designer's Phone Number: (360)426-5940
Mailing Address: 25381 N.US Hwy 101 Designer's Address: 2450 W Deegan Rd W
Hoodspot WA 98548 Shelton WA 98584
city State Zi city State Zip
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Treatment Device
❑Glendon Biofilter ❑Sand Filter ❑Mound ❑Sand Lined Dranfteld ❑Recumho ng Filter,Type:
❑Aerobic Unit Make/Model ❑Disinfection Unit Make Mudel Other: NIA
Draintield Type
@(Gravity ❑Pressure l4(Trench ❑Bed ❑ Sub Surface Drip
Septic Tanh/Drainfield Specifications Laterals
Number of Bedrooms 4 SchedulwClass 3034
Daily Flow:Operating Capacity 360 gpd Length 45,45,90, 90 It
Daily Flow:Design Flow 480 gpd Diameter 4 in
Septic Tank Capacity(working) 1,200 gal Number 4
Receiving Soil Type 0-6) 4 Separation 6 It
Receiving Soil Appl.Rate 0.6 gpd/ft' Orifices
Required Primary Area 800 ft' Total Number of Orifices pert. pipe
Designed Primary Area 800 ftr Diameter perf. pipe in
Designed Reserve Area 800 112 Spacing pert. pipe in
Trench/Bed Width 3 ft Manifold
Trench/Bed Length 270 ft Schedule/Class 3034
Elevation Measurements Length 70 ft
Original Bromfield Area Slope 12 % Diameter 4 in
New Slope,If Altered 12 aj Preferred manifold configuration used? O Yes PfNo
Depth of Excavation Uo-slope 12 in Transport Pipe
from Original Grade Do -slope 8 in Schedule/Class 3034
Designed Vertical Separation 36 in Length 80 It
Gravelless Chambers Required? ❑Yes O No 90ptional Diameter 4 in
Pump Required? ❑Yes Ed No Dosing and Pump Chamber
Pump/Siphon Specifications Number ofdoses/day Gravity
Diff.in Elevation Between Pump& Uppermost Orifice ft Dose quantity gal
Drainfield Squirt Height/Selected Residual(head) It Chamber Capacity(Hood) gal
Uppermost Orifice❑Higher ❑ Lower than Pump Shutoff Pump controls:Please check those required.
Capacity Q Total Pressure Head gpm OTimer Elapse Meter ❑Event Counter
Calculated Total Pressure Head it If Timer. Pump on
Comments W.�� "('G P p, JUNi 8 ^�fo
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DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 2 3 2 — 5 0 -- 2 1 0 0 6
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
RI Test hole locations 19 Drainfield orientation and layout Reference depth from original grade:
la Soil logs Trench/bed dimensions and Ed Septic tank
0 Property lines critical distances within layout IZ Drainfield cover
0 Existing and proposed wells Rf D-Box(Valve box locations Reference depth from original grade
within 100 It of property Ri Septic tank/pump chamber and restrictive strata:
m Measurements to cuts,banks,and locations 0 Laterals,trench/bed,top and
surface water and critical areas 69 Observation port location bottom
m Location and orientation of 19 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption Ed Manifold placement ❑ Sand augmentation
components
6ti Orifice placement Other cross-section detail:
19 Location and dimension of Ed Lateral placement with distance Rf Observation ports/clean-outs
primary system and reserve area to edge of bed
m Buildings Other Information
❑ Audible/visual alarm referenced Yes No
19 Direction of slope indicator R1 Scale of drawingshown on scale !6 ❑ Design staked out
g� Waterlines bar ❑ ❑Recorded Notices attached
it Roads,easements,driveways, ❑ ❑ Waiver(s)attached
parking ❑ ❑Pump curve attached
m North arrow and scale drawing ❑ ❑Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑ Waste strength
❑ ❑Flow
DESIGN APPROVAL
The undersigned designer must be nofifie i (er at time of installation 9 Yes ❑ No
Signature of Designer I Date �M
8 _
The undersigned has reviewed this design on behalf of Mason County Public Health and det to bein
compliance with state and local on- regulations: °y $
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Envi Health Specialist - Date sy w
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CAUTION: DESIGN APPRO AL IS VALID ONLY UNDER THE FOLLOWING CONDITIO
✓ 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 fro on County Public Health.
R0 E ffift
An Installation Fee is re uired. 1U
This form may be scamred and available for public view I� l('qu J Web OW.
- :',Updated Date: 12/7/2015
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Installation/Maintenance
Gravity Distribution/Trench Systems
1. Install trench bottom level and in contour with the ground.
2. Install drainfield during dry weather and soil conditions.Any soil smearing must be
eliminated by hand raking any areas that get smeared.
3. Divert all storm water run-off away from septic system components.
4. No curtain (french) drains allowed within 1 Oft. of the up-slope edge of the drainfield and
reserve area.
5. No curtain(french) drains allowed within 30ft. of the down-slope edge of the drainfield
and reserve area.
6. Have the septic tank pumped or inspected every 3 to 5 years.
7. All material and workmanship must meet County and State requirements.
8. Install risers on septic tank.
9. Deviation from this approved design without prior approval from the Designer and
Mason County Health Department will make this design null and void.
10.The prepared Site Plan is not a survey, it is the owner's responsibility to verify property
line locations prior to installation. Any discrepancies must be reported to the Designer
immediately.
11.Locate all utilities prior to starting installation-
MOM
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y Dale L..LTslye Fk
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LICENSED DESIGNER
JUN 18 2024
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