HomeMy WebLinkAboutSWG2024-00142 - SWG Application / Design / As-Built - 4/10/2024 N.
584
® MASON COUNTY 415N BSHELTON. 60427-O70,EXT 00
SHELTON:360d27@670,EXT 400
BE ELMA:36&aI82 a7,EXT 400
Public Health & Human Services ELMA:360i82-5289.EXT/00
FAX:366-427-7187
On-Site Sewage System Permit: SWG2024-00142
APPLICANT STICKLE DENNIS&DARLENE M Phone: 253-845-2283
Address: 12902 122ND AVE CT E PUYALLUP,WA 98374
OWNER STICKLE DENNIS&DARLENE M Phone: 253-845-2283
Address: 12902 122ND AVE CT E PUYALLUP,WA 98374
SEPTIC DESIGNER ROD LEFT' Phone: 360-698-8488
Address: PO BOX 2954 SILVERDALE,WA 98383
Site Address: 160 NE Mahogany Ct
Primary Parcel Number: 223097700260
Permit Description: New SFR-3BR Gravity w/class b waiver
Permit Submitted Date: 0 4/1 012 0 2 4
Permit Issued Date: 07/10/2024
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $705.00 caddulonal fee:may oa mawred uwn Insmlmfian ofaystemi.
Permit Expiration Date: 04/1 812 0 2 7 i.-deadaleofmwm.c l
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department staffper 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 Asbuik 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:
360427-9670, extension 400.
• � OFFICIAL USE ONLY -
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160 NE Mahogany Ct Belfair WA 98528 ^'
NAME CF OESIGER —E I N
Rod Left 360-698-8488
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THIS FORM MAY rvNED AND AVAJbWlVrFbR PUBLIC VIEW ON THE MASON COUNTY WESBRE REVISE.LZT.IS
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 2 2 3 0 9 — 7 7 — 0 0 2 6 0
A design will be reviewed when 3 copies 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 may be scanned and available for public view on the Mason County Web site.Muimom ptipe,si-e: 11"X17"
PARCEL IDENTIFICATION
Permit Number: SWG `�•Z - 0 c Designer's Name: Rod Left
Applicant's Name: Dennis&Darlene Stickle Designer's Phone Number: 360698-8488
Mailing Address: 12962122nd Ave Ct E Designer's Address: PO Box 2954
PUYWWP WA M74 SHeamale WA 9B 3
City State Zip City State zip
_ DESIGN PARAMETERS
Treatment Device
❑Ol.rxim Bivfilter ❑Sand Filter ❑Mound ❑Sand Load Drainfidd ❑Recimulating Film,Type:
❑Aerobic Unit Make/Modcl 0 Disinfection Unit Maks/Model Other:
Drainfield Type
lifGmvity ❑Pressure ❑Trench ❑Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class 40
Daily Flow:Operating Capacity 270 gpd Length 50 It
Daily Flow:Design Flow 360 gpd Diameter 4 in
Septic Tank Capacity 1250 gal Number 4
Receiving Soil Type(1-6) 4 Separation 5 li
Receiving Soil Appl.Rate 0.6 gpd/fe Orifices
Required Primary Area 600 ftr Total Number of Orifices NA
Designed Primary Area 600 ftr Diameter NA in
Designed Reserve Area 600+ 82 Spacing NA in
TremchBed Width 3 ft Manifold
Trench/Bed Length 200 ft Schedule/Class NA
Elevation Measurements Length NA li
Original Drainfield Area Slope 10-15 a/ Diameter NA im
New Slope,if Altered 10-15 % Preferred manifold configuration used? []Yes []No
Depth of Excavation Up-slope in Transport Pipe
from Original Grade De.-.kpe 10 in Schedule/Class 40
Designed Vertical Separation 18 in Length 50 ft
Gomelless Chambers Required? ❑Yes 0 No Rf Optional Diameter 4 in
Pump Required? 0 Yes If No 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 ft Chamber Capacity NA gal
Uppermost Orifice[]Higher 0 Lower than Pump Shutoff Pump controls:Please check those required.
Capacity B Total Pressure Head gpm []Timer []Elapse Meter ❑Event Counter
Calculated Total Pressure Head It If Timer: Pump on ,Pump off
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number.2 2 3 0 9 — 7 7 — 0 0 2 6 0
Permit Number SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
It Test hole locations 19 Drainfield orientation and layout Reference depth from original grade:
is Soil logs Ed Tmnch/bed dimensions and Rf Septic tank
19 Property lines critical distances within layout 13 Drainfield cover
In Existing and proposed wells Ed D-BoxfValve box locations
R of r Reference depth from original grade
within I00 property � Septic tank/pump chamber and restrictive strata:
It Measurements to cuts,banks,and locations ST Laterals,trench bed,rap and
surface water and critical areas 19 Observation port location bottom
❑ Location and orientation of lb Clean-out location ❑ Curtain drain collector
curtain drain and all absorption ❑ Manifold placement ❑ Sand augmentation
components 19 Orifice placement Other cross-section detail:
lb Location and dimension of ❑ Lateral placement with distance 19 Observation ports/cleanouts
primary system and reserve area to edge of bed
In Buildings Other Information
❑ Audible/visual alarm referenced Yes No
m Direction of slope indicator Rf Scale of drawing shown on scale ❑ Ed Design staked out
Id Waterlines bra ❑ ❑Recorded Notices attached
1J Roads,easements,driveways, Rf ❑Waiver(s)attached
parking ❑ 61 Pump curve attached
It North arrow and scale drawing ❑ E6 Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑Waste strength
❑ ❑Flow
DESIGN APPROVAL
The undersigned designer must be notified by install at time of ingnifiation R1 Yes ❑ No
� �'2zwzfr
Signs signer 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 regulat ons:
I ���z
Enviro a ]th Specialist Daze
CAUTION: DESIGN APPROV IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Apart, "by Mason County Public Health. / p
✓ The Onsite Sewage Pemdt 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 Data: 12/72015
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