HomeMy WebLinkAboutSWG2024-00004 - SWG Application / Design - 1/3/2024 ® MASON COUNTY 415NB SHELTON: , 0427-970,EXT 400
SHELFAIR 360-02754410.EXT 400
BELFAIR:380.2]5446].E%T 400
Public Health & Human Services ELMA:360.482.5269,EXT 400
FAX 360127-7787
On-Site Sewage System Permit: SWG2024-00004
APPLICANT SMITH KEVIN&LAURA Phone:
Address: 3889 REFLECTION LN E PORT ORCHARD,WA 98366
OWNER SMITH KEVIN&LAURA Phone:
Address: 3889 REFLECTION LN E PORT ORCHARD,WA 98366
SEPTIC DESIGNER Lawrence Purdum-Apex Septic Design Phone: 253-509-9922
Address: PO Box 801 GIG HARBOR,WA 98335
Site Address: 361 NE Southridge Rd
Primary Parcel Number: 322237700130
Permit Description: New 3-bedroom Glendon BloFilter
Permit Submitted Date: 01/03/2024
Permit Issued Date: 09/03/2024
Issued By: David Anderson
Current Permit Fees Paid: $1,135.00 (addltonal fees may be required upon lnelanewn or rystam).
Permit Expiration Date: 01/09/2027 (based on agile a 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 Dramfield installation not to exceed designed ups/ope and downslope depth specked 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 Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
7 Must follow all recommendations from Geotechnical engineer. Must prepare full
Geotechnical report prior to submitting for a building permit or constructing any structures.
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.govlhealth/environmental/onsitelossinspectionaequest.php or call:
360-427-9670,extension 400.
A OFFICIAL USE ONLY r
S
MASON COUNTY PUBLIC HEALTH "" 2
ONSITE SEWAGE SYSTEM APPLICATION MWNBgND N MDBM m ((A
415 N 6th Street(Bldg 8) Shelton WA,98584 '410 M w
Shelton:360427-9670eA4M 1064,360-2754167ea400 SWIG (A A
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Z W
APPLICANT PRONE D
Kevin Smith (253)222-2967 m M
m
"UNIGMORESS-STREET CT,,STATE,LP CODE r
3889 Reflection Ln E, Port Orchard, WA 98366 c
3
SIIEAODRESS-STREET CT,ZIP CODE OJ
NE Southridge Dr m
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NAME OF DESIGNER PHONE Il .
Lawrence Purdum/Apex Septic Design LLC 253509-2579 �N
NAME OF INSTALLER PHONE
Not yet determined
CXECKALLAPPLICABLEFFEMS ORINKINI 9NTER SOURCE 0 ^N
` V
13 NEW CONSTRUCTION [3 RV HOLDING TANK ONLY tj PRNATE INONIDUAL WELL N C
D REPLACEMENT SYSTEM D INSTALLATION PERMIT ONLY D PRNATETNO-PARTYWELL 2
D TABLE 9 REPAIR D SINGLE FAMILY D COMAUNITYIPUBLIC MWR SYSTEM
❑ TANUSI ONLY D COMMERCIAL SYSTEM NAME' �I
❑ UPGRADE TO EXISTING ❑ OTHER'. BEDROOMS LOTSNE I N
D EXISTING FAILURE "FNNEdSWn9 WNASL 2 5.02 aC m
nnwmNMMaPW^ r
DIRECTIONS TOSITE-BE SPECOIL AND ADVISE OFANY NEEDED INFORIMTION FOR ACCESS NMI n
See vicinity map on site plan.
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9OEMMTBEMI�FHWpY MAW ROMIAMD TESTNOIES MUSTBE FIADDm ININ N!B1NtllMM91d IO
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE IFAWRE SOURCE(M MpNpI,)
DVOLUNTARY OMAINTENANCENUMPING DBUILDINGPERMFF DHOMESALE DCOMPLAINT OOTHER'.
INSPECTOR SOIL LOGS COMMENTSICONODpIL4
r*s=a-zy Est
Pest of t4- NAv+ �yi�'-L/
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SOILCODES:
I V=VERY G=GRAVELLY S=SNID L-LOAM Sp-SILT C-CLAY E=EXTREMELY R-ROOTS
NSPECTOR SIGNANRE DATE APPLICATION EXPIRATION DATE MPIIGTIONMPROVEDBY MTE
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THIS FORM MAY BE SCANNED NDAVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY MINIM REVISED tN/ro13
t , DESIGN FORM-PAGE ONE Assessor's Parcel Number: 3 2 2 2 3 __ 7 7 __ 0 0 1 3 0
A design will be reviewed when 3 copies of each of the following are submitted:
V Completed design form that has been signed and dared. °Scaled layout sketch,including all applicable items on checklist
Scaled plot plan,including all applicable items on checklist. O Cross-section sketch,including all applicable items on checklist.
This loam maybe sinned and available for public view on the Mason County web site.Maximum paper size.' 11"X 17"
/^� II JJ PARCEL IDENTIFICATION
J/Permit Number: SWG� Y�L40 —1 Designer's Name: Lawrence Purdum
Applicant's Name: Kevin Smith Designer's Phone Number: 253-509-2579
Mailing Address: 3889 Reflection Lane E Designer's Address: PO Box 801
Port Orchard, WA 98366 Gig Harbor, WA 98335
city state Zi city State Zip
"DESIGN PARAMETER3
Treatment Device
❑Glendon Biofilter ❑ Sand Filter 91 Mound ❑Sand Lined Drainfield ❑Recirculating Filter,Type:
❑Aerobic Unit Make/Model Glendon M-31 ❑Disinfection Unit Make/Model Other:
Drainfield Type
❑Gravity IN Pressure ❑Trench ❑Bed 0 Sub Surface Drip
Septic Tauk/Drainfield Specifications Laterals
Number of Bedrooms �3 Schedule/Class N/A
Daily Flow:Operating Capacity ? '560 gpd Length N/A ft
Daily Flow:Design Flow 4?(I() 270 gpd Diameter N/A in
Septic Tank Capacity 1,250 — gal Number N/A
Receiving Soil Type(1-6) 4 Separation N/A ft
Receiving Soil Appl.Rate 0.6 gpd/Rt Orifices
Required Primary Area 600 ftz Total Number of Orifices N/A
Designed Primary Area 614 — ftt Diameter N/A in
Designed Reserve Area 600 — R' Spacing N/A in
Trench/Bed Width N/A ft Manifold
Trench/Bed length N/A ft Schedule/Class 40
Elevation Measurements Length 15 ft
Original Drainfield Area Slope 3.6 % Diameter 1.5 in
New Slope,If Altered N/A % Preferred manifold configuration used? IJ(Yes 0 No
Depth of Excavation U"Il NIA in Transport Pipe
from Original Grade Dawnsiope N/A in Schedule/Class 40
Designed Vertical Separation 12 in Length 79 ft
Graveness Chambers Required? -0 se-G Ale—Q9piieaal Diameter 2-In in
Pump Required? J(I Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number ofdows/day Proprietary
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity Proprietary gal
Orifice +A 10' ft Chamber Capacity 1,250 gal
Uppermost Orifice R Higher ❑Lower than Pump Shutoff Pump controls:Please check those required.
Capacity Q Total Pressure Head 10 gpm Winter NElapse Meter 0(Event Counter
Calculated Total Pressure Head 15.4 ft If Timer: Pump on PfODfletaN ,Pump off Proprietary
Comments
Redesign from previously-submitted application
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 3 2 2 2 3 __ 7 7 __ 0 0 1 3 0
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
M Test hole locations 00 Drainfield orientation and layout Reference depth from original grade:
IN Soil logs ❑ Trench/bed dimensions and ® Septic tank
® Property lines critical distances within layout ❑ Drainfield cover
CO Existingand proposed wells ❑ D-BoxfValve box locations
Pr !" Reference depth from original grade
within I00 ft of property M Septic tank/pump chamber and restrictive strata:
R Measurements to cuts,banks,and locations ❑ Laterals,trenchlbed,top and
surface water and critical areas M Observation port location bottom
❑ Location and orientation of 00 Cleanout location ❑ Curtain drain collector
curtain drain and all absorption N Manifold placement ❑ Sand augmentation
components ❑ Orifice placement Other cross-section detail:
lW Location and dimension of ❑ Lateral placement with distance Q§ Observation ports/cleanouts
primary system and reserve area to edge of bed Other Information
0➢ Buildings M Audible/visual alarm referenced Yes No
❑ Direction of slope indicator M Scale of drawing shown on scale ❑ M Design staked out
* Waterlines bar ❑ M Recorded Notices attached
00 Roads,easements,driveways, ❑ M Waiver(s)attached
parking M Pump curve attached
* North arrow and scale drawing ❑ IN Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑ Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be notified by installer at time of installation M Yes ❑ No
7/2312JA
Signature of Designer Dat7TPP
The undersigned has reviewed this design on behalf of Mason County Public Health and d(r 'ned it�b
compliance with state and local on-site lations: * p p �O
j Z 1/ soN0oU h 3101y
Environmental Health Specialist Date D✓gON' e*";,v H�IrN
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health.
✓ I
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 W b site.
Updated Daze: 12/7/2015
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