HomeMy WebLinkAboutSWG2024-00222 - SWG Application / Design - 5/20/2024 ® MASON COUNTY 015 N6THELTON: 60427TO70.EXT 586
SHELTON:W-27 -9870,EXT COB
BELFAIR:360-2751C87,E%T 400
Public Health & Human Services ELM:360182-5269,EXT COO
FAX 380127-T787
On-Site Sewage System Permit: SWG2024-00222
APPLICANT BO RUSSELL• Phone: 360589-7957
Address: PO BOX 336 MONTESANO,WA 98563
OWNER KWON JAMES Y&KIM S Phone:
Address: 502 S 1 ST ST MADILL,OK 73446
SEPTIC DESIGNER CHRIS ELSTROTP Phone: 360561-5000
Address: 128 NORTH RIVER STREET MONTESANO,WA 98563
SEPTIC INSTALLER RUSS CONSTRUCTION LLC Phone:
Address: PO BOX 336 MONTESANO,WA 98563
Site Address: XXX E Peale Dr
Primary Parcel Number: 219015000063
Permit Description: 3-bedroom gravity system
Permit Submitted Date: 05/20/2024
Permit Issued Date: 08/2112024
Issued By: David Anderson
Current Permit Fees Paid: $805.00 leas m,br weir nmiiawn of sy ml.
Permit Expiration Date: 05/30/2027 (b.W.rdeb W lwpegbn)
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 Dreinfie/d installation not to exceed designed upslope and downslope depth speed 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 CountyAsbuiO 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:masonwuntywa.govklealthlenvironmentagonskeloss4nspectlonfequest.php or call:
360-427.9670,extension 400.
OFFICIAL USE ONLY
MASON COUNTY DMEFLENSO
COMMUNITY SERVICES AMOUNT IMF° aU FLIVVEGB m y
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ON-SITE SEWAGE SYSTEM APPLICATION
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SITE ADDRESS.STREET CITY ZIP LODE
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NAME OF DESIGNER PHONE I`
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NMIE OF INSTALLER PHONE O Ib
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PERMRTVPE Wetl oneJ oo GRINNING WATER SOURCE O
ESIDENTIALO.SS 6COMMUNITYOSS E.ECOMMERCIALOSS ff PRIV TE INDIVIDUAL WELL f PRIVATE TWO-RARTYWELL 2 L
rvPE OF WO (nlxiono) CC UBLIC WATER SYSTEM IuI/S�acss� Ef7. I I`I
W CONSTRUCTION I UPGRADES L-I,:REPpIRI REPLACEMENT OTHERDETMLS(aeLeeNMeuppyl ❑ TABLE IX REPAIR N IG
SUBMITTALS ❑ SURFACING SEWAGE ❑EXISTING FAILURE ❑SHORELINE m
ffVrS_[GN FORM(REQUIRED) gerl.DESIGN(REQUIRED) BEDROOMS LOT bRE Q I
6,WAIVER(S)(IF APPLICABLE) 3 B.$2 1(G,
DIRECTIONSTOSREAND SITE CONDITIONS.(a k. OSpeb)
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OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(M npoWg Purynes)
[3VOLUNTARY ❑MAINTENANCEPUMPING OBUILDING PERMIT ❑HOMESALE ❑COMPLAINT CIOTHER:
INSPECTOR SOIL LOGS /&-f_ -L OOMMENTSICONDRION
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3fRECORDDRAWNGANOWSOIL CODES:V=VERY G=GRAVELLY b=SAND L=LOAM SI=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINMAPPNSP IGNATURE MTE APPLICATION EXPIRATIpi GATE MPLI ION APPROVEOI I0 ZUL S
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 1XM2015
DESIGN FORM-PAGE ONE Assessor's Parcel Number: 2 OQ a-"
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 maybe scanned and available for public view on the Mason County Web Nte.Maximum papersize: 1/"XI7 '
PARCEL IDENTIFICATION
Permit Number: SWG j� � Designer's Name:
Applicant's Name: Bo .Fwss--- Designer's Phone Number: JX&_ S"6 /- Seioa
Mailing Address: IRI,50,e 33 to pq.� Designer's Address: /26 Al ,921G[ 57
/yyd A-r+war. /,e//A �fs'/3 /J1cn YEr.rne ,!✓fj 9Ca'i%3
Ci State zi Ci State Zi
GN PARAMETERS
Treatment Device
O Glendon Biofilter ❑Sand Filter ❑Mound ❑ Sand Lined Dminfield ❑Recirculating Filler,Type:
❑Aerobic Urn Make/Model ❑Disinfection Unit Make/Model Other:
// Drr+nfield Type
M15C ity ❑Pressure M- nch ❑Bed ❑Sub Surfacc Drip
Septic Tank/Drainfield Specifications - F✓« Laterals
y .,C,X
Number ofBedrooma; 3 , Sys
Daily Plow: Operating Capacity .r6p- gpd Length ft
Daily Flow:Design Flow 31/0 gpd Diameter in
Septic Tank Capacity(working) )",y gal Number
Receiving Soil Type(1-6) y F Separation ft
Receiving Soil Appl.Rate o. 6 - gpd/fiz Orifices
Required Primary Area /'bp fe Total Number of Orifices ,yt'
Designed Primary Area Gpp fi Diameter in
Designed Reserve Area �p0 ft' Spacing
Tre.IhBed Width 3 _ ft Manifold
1r.cch/Bed Length 290 ft Sch Class 303/
Elevation Measurements Length 6 It
Original Drainfield Area Slope '/ a/o Diameter y in
New Slope,If Altered 5/ a/o Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Up-kfe _76 in Transport Pipe
from Original Grade Dow ,I,, J in Schedule/Class ro sy
Designed Vertical Separation .3� i in Length 5/ r ft
Gravelless Chambers Required? ❑Yes 0 No 0 Optional Diameter y/ in
Pump Required? ❑Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications N ofdoses/day
Di evation Between Pump&Uppermos ce ft Dose quantity gal
Dra�eld Squirt et lest t ual(head) _ft Chvnber Capacity(flood) gel
Uppermost Orifi Cher O Lo Pump Shutoff Pump controls:Pie eck those regmr
Capaci otal Pressure Head OT' OElapse Meter ❑Even
alculated Total Presame Head ft If Ti er: Pump on Pump off
Comments
DESIGN FORM—PAGE TWO Assessor's Parcel Number: 2 Z_9 0 / -- f0 -- Qdo 63
Permit Number: SWG
DESIGN CHECKLISTS
Scale Plot Plan Scaled Layout Sketch Cross-Section Sketch
Te hole locations nfield orientation and layout Reference depth from original grade:
❑'Soil logs Treth/bed dimensions and (9_SSyypptic tank
�perty lines ,�,/�r"cal distances within layout C�Dminfield cover
Existing and proposed wells 13 D�alve box locations Reference depth from original grade
w/�,m ]00 ft of property arroc tank/pamp-eheffibar and restrictive strata:
Cd' Measurements to cuts,banks,and ,rations El Laterals,tryarJt/bed,top and
s ace water and critical areas 201,
servation port location bottom
�abon and orientation of 20an-out location ,2f' Curtain drain collector
curtain drain and all absorption [2 Manifold placement yi Sand augmentation
� /comp-onents �Orifice placement Other cross-section detail:
LYLocation and dimension of Lateral placement with distance ❑ Observation ports/cleanouts
system and reserve area to to a of bed
uildings g Other Information
-- // Audible/visual alarm referenced Yes No
[3�I ' ection of slope indicator [71-IS-cale of drawing shown on scale ❑ ign staked out
terlines bar ❑ 5porded Notices attached
Buds,easements,driveways, ❑ G'W er(s)attached
� piar�king ❑ ❑ p curve attached
WiNorih arrow and scale drawing ❑ valuation of failure
shown on scale bar I Non-r9xidentlidjustificathm
Waste strength
Flow
DESIGN APPROVAL The undersigned designer must be notified by installer at time of installation ❑Yes ❑ No
� s 17- �y
Signature of Designer Da
A
The undersigned has reviewed this design on behalf of Mason County Public Health and/d" in
compliance with state and local one regulations: D
i g�zr/logy MASONS5}}, AUO? �?014
n romnental Health Specialist DatV'yENpIRONM
D,Jdd ENTqq//,,,,,,..
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CADITIOIV' 178
✓ The design is stamped"Approved"by Mason County Public Health.✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: S/AO 17,OZZ
✓ 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 Date: 12n/2o15
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