HomeMy WebLinkAboutSWG2024-00269 - SWG Application / Design - 6/13/2024 HELTON,
WA9
584
MASON COUNTY 415N BSHELTONSTREET, 0427-11 ,EXT 400
SHELTON:360-27 - 70.EXT400
BELFAIR:360-2]Si46],E%T 400
Public Health & Human Services ELM:36"82-5269,EXT400
FAX 360427-7787
On-Site Sewage System Permit: SWG2024-00269
APPLICANT STEVENS DAVID LAWRENCE & Phone: 360-551-8826
MEKENZIE JANE
Address: PO BOX 2626 BELFAIR,WA 98528
OWNER STEVENS DAVID LAWRENCE& Phone: 360-551-8826
MEKENZIE JANE
Address: PO BOX 2626 BELFAIR, WA 98528
SEPTIC DESIGNER Jim Zimny Phone: 360-516-7287
Address: 7178 WINDFLOWER PL NW SEABECK,WA 98380
Site Address: UNKNOWN
Primary Parcel Number: 221232250070
Permit Description: New 4bd gravity trench with Class B waiver
Permit Submitted Date: 06/13/2024
Permit Issued Date: 07/29/2024
Issued By: Rhonda Thompson
Current Permit Fees Paid: $540.00 landidonaINesmaybe regoo-eda9onmsmaadanmspunni
Permit Expiration Date: 06124/2027 (based on dale a mspeaion)
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 DesignerlEngineer 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/environmentallonsiteloss-inspection4equest.php or call:
360-427.9670,extension 400.
OFFICIAL USE ONLY
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APPLICANT R1JNE m m
David Stevens 366 551-8826 Pt- Z
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PO BOX 2626 BELFAIR WA 98528 00
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lot 7 Adoni P; Grapeview — N
NAMEOFO GN R10NE
Jim Zimny 360-516-7287 N
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From Hwy 3 take a rt on Grapeview loop Rd, go .6 mi and take rt on E Thomas Rd, go 1 mi e
and take left on E April Ave. follow .4 miles to Adoni Rd, take rt at gate( Gate Code//7817).
follow to the end of rd lot is on the left makes w/pink ribbons. Go down cleared driveway o O
and test holes are marked to the rt and left. Site is cleared and easy to navigate.
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DESIGN FORM-PAGE ONE Assessor's Parcel Ntmtbe . 221232250070- __ - _____
A dealgo w W be miewed wbm 3 muk~ of®cb of the folbwiag are submitted:
•Completed design form that has been signed and dated I Scaled layout sketch including all applicable item on checklist
•Scaled plot plan,including all applicable items on checklisL 'Cross tion sk h,including all applicable item on checklist.
Thisro, ma bey fwwdmWavaiLibMforpublicviewmthaNason Web site Mruimun,papersae: 11"X17"
PARCEL IDENTIFICATION
Pernut Number. SWGZeq�� Designer's Name: Jim Zlmny
Applicant's Name:
David Stevens: Designer's Phone 360,516-7287
Mailing Address: PO BOX 2626 Designers Address: 7178 Windawp pl.NW
BELFAIR WA( 98528 Seebenlc WA 98380
® City §t9f ZAP City late Zip
DESIGN PARAMETERS RRnn
Treatment Device W
❑Glendon BioSber ❑Sand Filter ❑ Mound ❑Send Lined Drai dield Recirculating Filter,T J
❑Aerobic Unit M&Wodel ❑Ilishnfection Umt Mat Mndcl
Dreinfield Type
lyCnavtty ❑Presume lfTTencb 1115013 OSob Surface
Septic TanklDrainfiald Specifications Laterals
Number of Bedrooms 4 Scledule/Class 3034
Daily Flow:Operating Capacity 060 glad Length 67 ft
Daily Flow:Design Flow — gpd Diameter 4 in
Septic Tank Capacity (working) 2OO gal Number 4
Receiving Soil Type(1-6) Separation 5 ft
Receiving Sot?AppL Rare 0.6 gpd/fO Orifima
Required Primary Area Sao lie Total Number of Orifices NA
Designed Primary Area ,800 fte Diameter in
Designed Reserve Area 00 ft7 spacing in
Trench/Bed Wash 13 ft Manifold
TreachBed Length[ atv-E ft schedule) rf v NA
Elevation Measuremeph Length .' ', �`"c ft
ucr:r -
Original Drambeld Area Slope % Diame
in-1s.7-N
New Slope,if Altered % Preterred m(-r; coImamum used? ❑Yes O No
Depth of Excavation ui, t90N j� /p _ in Transport Pipe
from OriginalCnade u°wm siovs fj in Schdule/Class 3034
Designed Vertical Separation inLength
5' ft
Gravelless Chambers Required? ❑Ye E3 No Of Optional Diameter 4 in
Pump Required? O Yes ❑No Dosing and Pump Chamber
Pump/Siphon Specificaltions Number of do day
Diff.m Elevation Between Pump&Uppermost Orifice ft Dose quantity gal
Drainfield Squirt Heig1W Selected Residual(head) _ft Chamber Ca (flood) gal
Uppermost OfficeO Higher O Lower this Pump Shutoff - Pimp controls: check these inquired.
Capacity @ Total Pressure Head gpm OTimer OElapse Meter ❑Event Counter
Calculated Total Pressure Head R ,Pump off
Comments
JUL 29 024
MASON COUNn ENVIRO IMENIALHEALTH
DESIGN FORM—PAGE TWO Aaaeaaora Panxl 221292750W0. _
PcrmitNumbcr. Slat-- — —
-----
j DESIGN CFIECKLI
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
9 Test hole locations B Dminfield orientation and In Reference depth fiom original grade:
Iff Soil logs If Trench/bed dimensions and Ef Septic tank
0 Property lines critical distances within layc H Dminfield cover
• Existing and proposed wells Id D-BoxfValve box locations Reference depth from original grade
within 100 ft of property I 19 Septic tank/pump chamber and restrictive strata:
0 Measurements to cuts,banks,apd locations Iff Laterals,trench/bed,top and
surface water and critical areas I f Observation port location bottom
0 Location and orientation of ! H Clean-out location ❑ Curtain drain collector
curtain drain and all absorption ❑ Manifold placement ❑ Sand augmentation
components ❑ Orifice placement Other cross-section detail:
Iff Location and dimension of If lateral placement with di ce 9 Observation ports/clean-outs
primary system and reserve are to edge of bed
Iff Buildings Other Information
❑ Audible/visual alarm referenced Yes No
0 Direction of slope indicator 19 Seale of drawing shown on e ❑ Iff Design staked out
Iff Waterlines bar ❑ ❑Recorded Notices attached
• Roads,easements,driveways, 17 ❑Waivers)attached
parking ❑ ❑Pump curve attached
• North arrow and scale drawing ❑ ❑Evaluation of failure
shown on scale bar . Non-residential justification
rxwris_` `•':fxa ❑ ❑Waste strength
it
❑ ❑Flow
D GN APPROVAL
The undersigned designer must be notified by 17!7
on 6Yes ❑ No
2y
Signature of 10,4gV Date
The undersigned has reviewed this design on behalf of Mason Courtly Pit fic Health and determined it to be in
compliance with state and local omsite regulations:
Eav"ental Heafth Specialift Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THI,FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. r /
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Dal 5 is:
✓ Drainfield site conditions have not been altered to adversely affect co 'lions of design approval.
Please Note: The system must be installed a certified installer,
unless prior authorization is obtained from ason County Public Health.
An Installation Fee is required.
This form maybe scanned and available for public view on the Mason County Web site.
Updalcd Date. 12/7/2015
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Advant* ge Perc & design
Timely•Reasorlable•30 Years of Local,
oca Experience
Construction Notes for Gravity 4 Bedroom System:
Equal Distribution w/graveless chambers(Rock and pipe maybe substituted)
Install 4—68' Laterals w/6 hole d-box.
Install on 5'foot centers.
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Install 8"deep on low side of trench maintain 18"of vertical separation
Install level and along contours.0
Install in dry weather only.
Use 1200-Gallon septic
System designed for typical residential waste strength sewage only. APPROVED
System designed for 480 Gallons Per Day JUL 29 2024
MASO COUNTY ENVIRONMENTAL HEALTH
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1 JUL 29 2024
ASON COUNTY ENVIRONMENTALHEALTH
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