HomeMy WebLinkAboutSWG2024-00364 - SWG Application / Design - 8/27/2024 WA
MASON COUNTY 415N6THELTON: 0427-9N ,EXT404
SHELTON:360-027-96]0.EXT 400
BELFAIR:360-275-0467,EXT 400
Public Health & Human Services ELMA:360482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2024-00364
APPLICANT HEALY FRANCES RENEE Phone: 253-222-1509
Address: 4229 W ARSENAL WAY BREMERTON,WA 98312
OWNER HEALY FRANCES RENEE Phone: 253-222-1509
Address: 4229 W ARSENAL WAY BREMERTON,WA 98312
SEPTIC DESIGNER ROD LEFT` Phone: 360-698-8488
Address: PO BOX 2954 SILVERDALE,WA 98383
Site Address: 40 NE SCHOONER PL
Primary Parcel Number: 123305200015
Permit Description: Repair 2bd gravity system
Permit Submitted Date: 08/27/2024
Permit Issued Date: 09/03/2024
Issued By: Rhonda Thompson
Current Permit Fees Paid: $540.00 (addict io..I fees may be,epmred apoo maollauon or system).
Permit Expiration Date: 08/27/2027 (based on dale of inspection)
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department sfaffper 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.
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/onsiteloss-inspection-request.php or call:
360.427.9670, extension 400.
OFFICIAL USE ONLY
MASON COUNTY ATEN�ENED -2-7
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ON-SITE SEWAGE SYSTEM APPLICATION 3
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APPLICANT PNONE I" m
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Renee Healy z
LINGADURESS-STREET.GTY STATE NE CODE a
4229 W. Arsenal Way Bremerton WA 98312 p
SITE ATEREss-STREET,Cl.SIR CODE
40 NE Schooner PI Belfair WA 98528
NAMEOFDESIGNE0. PNONE N
Rod Left 360-698-8488
NAME OF ws-uLea PLaNE ED I W
PERMITTWE(e.recl, D c .NSDURGE E5 I W
®RESIOENTIALoss 4COMMUNITYOss 13COMMERCIA,CSS EIPRIVATE INDIVIDUAL WELL EPPRIVATE TWO PARTY WELL $ O
TYPE OF wow<(aereewa) ®PUBLIC WATER SYSTEM SNRHA Cwe
E1j NEWCONSTRUCTON/UPGRADES 9.EPAIRIREPINCEMENT ETAas(aeren au lnaupdyl ❑TABLE IX REPAIR Ul
Tx5 D D SURFACING SEWAGE Cl EXISTING FAILURE ❑SHORELINE
suRDESIGN FORM(REQUIRED) UISEPTIC DESIGN(REQUIRED) BEDROOMS LOTMSE r N
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GII£YUSTBEFUGGED FROMMAIN ROAG ANUIEST XOLES MUST6EFLAGGEG NTN iETT XOLENVYBER; I
OFFICIAL USE ONLY BELOW THIS LINE
uwRAQEI FAILURE souRCE(a.+ps+ms PamN+�) 20
❑VOLUNTARY 0MAINTENANCEIPUMPING ❑BUILDINGPERMIT OHOMESALE ❑COMPLAINT DOT I
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AUG 27 2024
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RECORD DRAWING AND NNTALLATION REPORT
SOUCODE
•VERY =GRAVELLY S=CAND L=LOAM M-SILT
=CLAY E=E%TREMELY R=ROOTS REQUIRED FOR FINAL APPROVAL
INSPECTOR SIGNATURE DATE MPQG➢ONEXPIRATRINDATE APPLICATION APPROVED/ISSUED BY DATE
THIS FORM MAY BES ANNED AND AVAILABLE FOR PUOL&VEW ON THE MASON COUNTY WEBSITE REVISED UI@015
DESIGN FORM—PAGE ONE Assessor's Parcel Number 1 2 3 3 0_ — 5 2 — 0 0 0 1 5
A design will be reviewed when 3 copies or each of the following are submitted:
e 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 he scanned and available for public view on the Mason County Web site.Marimuse paper size: 11"X 17"
_ 3*z;t•
Permit Number SWG 6LT Designer's Name. Rod Left
�Applicant's Name Renee Healy Designer's Phone Number: 360-698-8488
:
Mailing Address: 4229 W.Arsenal Way Designer's Address: PO Box 2954
bremedon WA 98312 Sivindale WA 98383
City State Zip City State Zip
v. ;i J DYSIGSTPARAM1;'TA.ItSe.: P t., ,r r .. •"k#>.r
Treatment Device
❑Glendon Biofiher ❑ Sand Filter ❑Mound ❑Sand Lined Drainfield ❑Recirculating Filter, Type:
❑ Aembic Unit Mak.1bsEt ❑ Di,mficohou Unit Make/INod,l Other:
Drainfield Type
gGravity ❑Pressure ❑Trench ❑ Bed ❑Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number ofBedroems 2 Schedule/Class 3034
Daily Flew:Operating Capacity ) JO gpd Length 45 ft
Daily Flow Design How 240 gpd Diameter 4 in
Septic Tank Capacity® 100o gal Number 3
Receiving Sol Type Q 4�-6) 4" Separation 10 ft
Receiving Soil AppL Rate .6 gpd/ft' Orifices
Required Primary Area 400 fto Total Number of Orifices NA
Designed Primary Area 400 ftt Diameter NA in
Designed Reserve Area 400 E, Spacing NA in
Trench/Bed Width 3 It Manifold
Trench/Bed Length 135 IF Schedule/Class NA
Elevation Measurements Length NA it
Original Drainfield Area Slope 0 % Diameter NA in
New Slope, If Altemd 0 % Preferred manifold configuration used? O Yes ❑No
Depth of Excavation upelove 30 in Transport Pipe
from Onginal Grade ne. ., 30 in Schedule/Class 3034
Designed Vertical Separation 36 in Length 25 ft
Goevelless Chambers Required 1 ❑Yes ❑No RfOptional Diameter 4 in
Pump Required? ❑Yes fidNo Dosing and Pump Chamber
Pump/Siphon Specifications Number of doses/day NA
Difference in Elevation Between Pump Shutoffand Uppermost Dose quantity NA gal
Orifice r" ft Chamber Capacity NA gal
Uppermost Orifice O Higher ❑Lower than Pump Shutoff Pump controls:Please check those required_
Capacity®Total Pressure Head NA gpm ElTimer ElElapse Meter ❑Event Counter
Calculated Total Pressure Head it If Timer Pump on ,Pump off
Comments
AF' F' " OVE D
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DESIGN FORM—PAGE TWO Assessor's Parcel Number 1 2 3 3 0 — 5 2 — 0 0 0 1 5
Permit Number SWG
DESIGN CHECKLISTS.
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Ed Test hole locations Drainficld orientation and layout Reference depth from original grade:
Ib Sol logs Trench/bed dimensions and 11 Septic tank
9 Property lines critical distances within layout ❑ Draimiield cover
❑ Existing and proposed wells 9 D-Box,Valve box locations Reference depth from original grade
within 100 ft of property IIM Septic tank/pump chamber and restrictive strata:
❑ Measurements to cuts, banks,and locations Z laterals, trench/bed,top mid
surface water and critical areas EX Observation port location bottom
Cl Location and orientation of [A Clean-out location ❑ Curtain drain collector
curtain dram and all absorption ❑ Manifold placement ❑ Sand augmentation
components ❑ Orifice placement Other cross-sectiondetail:
9 Location and dimension of W1 Lateral placement with distance 9 Observation putts/clean-outs
primary system and reserve area to edge of bed
g Other Information
Buildings ❑ Amhble/visual alarm referenced Yes No
lb Direction of slope indicator 21 Scale of drawing shown on scale ❑ d Design staked out
Waterlines bar ❑ lRf Recorded Notices attached
Roads,easements,driveways, ❑ 9 Waiver(s)attached
parking ❑ 64 Pump curve attached
R1 North arrow and scale drawing ❑ G9 Evaluation of failure
shown on scale bar Non-residential justification
❑ I�Waste strength
❑ E�Flow
DESIGN APPROVAL
The undersigned designer must be notified by imsta or at time o sinflation R1 Yes ❑ No
Signaty iof Designer 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:
13/z I
Er v¢enmental Health 5 ecrahst Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION-
✓ The design is stamped"Approved"by Mason County Public Health. k4 I
I ���
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is:
✓ Drainfield site conditions have rot 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: 17/7/2015
Mason County WA GIS Web Map
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