HomeMy WebLinkAboutSWG2023-00265 - SWG Application / Design - 6/23/2023 (2) MASON COUNTY 415Nfi SHELTON: 0427-97 ,EXT 400
SHELTON:STREET,SHELTON,
W EXT 400
BELFAIR:360-275-0 67,EXT 400
Public Health & Human Services ELMA:360482-5269,EXT 400
FAX 360427-7787
On-Site Sewage System Permit: SWG2023-00265
APPLICANT DELANY KIMBERLY A Phone: 360-280-2660
Address: 4190 E AGATE RD SHELTON, WA 98584
OWNER DELANY KIMBERLY A Phone: 360-280-2660
Address: 4190 E AGATE RD SHELTON, WA 98584
SEPTIC DESIGNER ROD LEFT-Acme Design Phone: 360-698-8488
Address: PO Box 2954 SILVERDALE, WA 98383
Site Address: 121 E LIZZY LN
Primary Parcel Number: 320242290012
Permit Description: New 3bd OscarX02-REVISION
Permit Submitted Date: 06/23/2023
Permit Issued Date: 09111/2023
Issued By: Rhonda Thompson
Current Permit Fees Paid: $1,105.00 (additbnalf..mey be.,md upon inswledon of ayalem).
Permit Expiration Date: 06/29/2026 (1,9 dandamonnsp von)
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 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 No clearing of vegetation or addition of impervious surface is permitted within the wetland
buffer.
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:
360.427.9670,extension 400.
r DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 0 2 4 — 2 2 — 9 0 0 1 2
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 sketchy including all applicable items on checklist
v Scaled plot plan,including all applicable items on checklist. v Cross-section sketch,including all applicable items on checklist.
This torn may be scanned and available for public view on the Mason County Web site.Maximum iasize: 11"XI7"
PARCEL IDENTIFICATION
2023-00265 Designer's
Permit Number. SWG Name: Rod Len
Applicant's Name: Falynn Auston g lam Delany Designer's Phone Nomber: 360-698-8488
Mailing Address: 20G2 45th St Ct NW Designer's Address: PO Boa 2954
Gig Harbor WA 96935 61Nmdab WA 99393
City State zio city State zip
Treatment Device
❑Glendon Biofiltm ❑Sand Filter Rf Mound ❑Send Lined Drainfield O Recirculating Filter,Type:
G(A.bic Unit MakNModel 09Car X02 0 Disinfxttioa Unit Malu,Model Other:
Drainfield Type
❑Gravity O Pressure 0 Trench ❑Bed 0 Sub Surf.Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 3 Schedule/Class XO.2
Daily Flow:Operating Capacity 270 gpd Length C 's—s0 ft
Daily Flow:Design Flow 360 gpd Diameter Cr't\9 in
Septic Tank Capacity 1500 gal Number
Receiving Soil Type(1-6) 5 Separation ft
Receiving Soil Appl.Rate 0.4 gpd/ftc Orifices
Required Primary Ares q00 fte Total Number of Orifices
Designed Primary Area ri00 fit Diameter in
Designed Reserve Area ri 00 1112 Spacing in
Trench/Bed Width tg it Manifold
TrenclrBed Length 50 ft Schedule/Class
Elevation Measurements Length it
Original Drainfield Area Slope 2 % Diameter in
New Slope,If Altered 2 % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-slaps N/A in Transport Pipe
from Original Grade lape N/A in Schedule/Class 40
Designed Vertical Separation 1'L4, in Length 60 it
Gravelless Chambers Required? ❑Yes Id No 0 Optional Diameter 1 in
Pump Required? Rf Yes O No Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day Pre-set
Difference in Elevation Between Pump ShutolT and Uppermost Dose quantity gal
Orifice a ft Chamber Capacity 1000 gel
Uppermost Orifice 0 Higher 0 Lower than Pump Shuloff Pump controls:Please check those required.
Capacity B Total Pressure Head 9,1 gpm OTimer CElapse Meter ❑Event Counter
Calculated Total Pressure Head (a-E/{ ft If Timer: Pump on 30 we Pump Off 3 min yp
Comments
T� s is G- cedcs�sr �m 3-t3e � OSS
JUL 29 2024
MASON COUNTY ENVIKUNWIAL IcAL111
RET
DESIGN FORM—PAGE TWO Assessor's Parcel Number.�3 2 0 2 4 — 2 2 — 9 0 0 1 2
jPenuit Number SWG Wl2n �2W
t{LIST&� . • "' •'. f ... • cfiic�
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
R1 Test hole locations M Dtainfield orientation and layout Reference depth from original grade:
16 Soil logs Ed Trenchibed dimensions and Ed Septic tank
R1 Property lines critical distances within layout G4 Dxandield cover
El Existing and proposed wells Rf D-Box/Valve box locations Reference depth from original grade -
within 100 R of property Rf Septic tank/pump chamber and restrictive strata:
19 Measurements to cuts,banks,and locations IZ Laterals,trenchNed top and
surface water and critical areas 19 Observation port location bottom
❑ Location and orientation of 19 Cleanout location ❑ Curtain drain collector
curtain drain and all absorption ❑ Manifold placement ❑ Sand augmentation
components ❑ Orifice placement Other cross-section detail:
Ed Location and dimension of 21 Lateral placement with distance ❑ Observation portslcleanouts
primary system and reserve area to edge of bed Other Information
la Buildings R1 Audible/visualalarm,ala referenced Yes No
16 Direction of slope indicator R1 Scale of drawing shown on scale ❑ Of Design staked our
0 Waterlines bur ElRf Recorded Notices attached
6d Roads,easements,driveways, ❑ b'j Waiver(s)attached
pang ❑ fd Pump curve attached
m North arrow,and scale drawing ❑ Id Evaluation of failure
shown on scale bar Non-residential justification
❑ El Waste strength
❑ ❑Flow
D I'SCGI'APPRO `-: v
09.
The undersigned designer most be notified by insta er time of installation ✓Yes ❑ No
-7 Ibzozy
Sigaat eofDesigner 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 regulations:
91NQ_X C«^M In,1AML(
Environmental Health Specrialist 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: b
ju
I Dramficld 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 Date: 12f72015
Mason County WA GIS Web Map
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