HomeMy WebLinkAboutSWG2024-00345 - SWG Application / Design - 8/13/2024 415N 6TH STREET
SHELTON, .EXT 400
SH ELTON.3fi0-02 967 EXT 584
MASON COUNTY
BELFAIR:360-275-4467,EXT 400
Public Health 8L Human Services ELVA,360-082-5269.EXT 400
FAX 360427-7787
On-Site Sewage System Permit: SWG2024-00345
APPLICANT FRANK CLARK Phone: 360-830-4765
Address: PO Box 1954 SILVERDALE,WA 98383
OWNER RHOE LARRY&MICHELLE Phone:
Address: 81 N LAKE CUSHMAN RD HOODSPORT, WA 98548
SEPTIC DESIGNER FRANKLIN CLAi Phone: 360-830-4765
Address: PO BOX 1954 SILVERDALE, WA 98383
SEPTIC INSTALLER FRANKLIN CLARK` Phone: 360-830-4765
Address: PO BOX 1954 SILVERDALE,WA 98383
Site Address: 61 N LAKE CUSHMAN RD
Primary Parcel Number: 422125110006
Permit Description: New 21 ATU to pressure bed
Permit Submitted Date: 08113/2024
Permit Issued Date: 0911712024
Issued By: Rhonda Thompson
Current Permit Fees Paid: $805.00 (additional fees may be,epmred upon installation of symem(.
Permit Expiration Date: 08/30/2027 (based on dare of 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 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 U 1; •
COMMUNITY SERVICES DU S NF m H
wumHmkh(Cem umtyHmun/Env nmental Heattm M C m
SWG _� p $
2 N
ON-SITE SEWAGE SYSTEM APPLICATION >
DO
DOA
APPLICANT PHGNE DO
r
Franklin Clark 360.830.4765 z
c
MAILINGAOORE55-STREET CITY$WTE,ZIP CODE 3
P.O. Box 1954 Silverdale,WA 98383 rn
SITE ADDRESS.sTREET.CITY ZIP CODE
z
81 N LAKE CUSHMAN RD, HOODSPORT,WA 98548 I
NAME OF DESIGNER PHONE I Franklin Clark 360.830.4765 IN)
NAME OF INSTALLER PHONE O I N)
Franklin Clark 360.830.4765 H
PERMITTYPETWddd,reJ DRINNING WATER SOURCE sai
■ RESIDENTIAL OSS [] COMMUNITY ONUS ❑COMMERCIAL OSS [] PRNATEINDNIDUALWELL ❑ PRIVATE TWO-PARTY WELL
TYPE OF MR.dvP .`dN ■ PUBLIC WATER SYSTEM PUD#1 Iv
0NEWCONSTRUCTION/UPGRADES ❑ REPAIR/REPtACEMENi OTHER DETAILS Disact all toad anMy [I TABLE IX REPAIR I /n
SUBMITTALS ❑ SURFACING SEWAGE []EXISTING FAILURE ❑SHORELINE IM v1'
* DESIGN FORM(REQUIRED) ■SEPTIC DESIGN(REQUIRED) BEDROOMS IOTS12E r I
❑WAIVER(s)(IF APPLICABLE) // 0.27 Acres 0
DIRECTIONS To SITE AND SITE CONDITIONS.LID eves aref r
Mason County Community Development 615 W Ader SC Shell NW 985U>Head ri on N Sir St toward W Alder S1>Turn Lek at 0a dal a osa dreet I O
onto W Alder St>Continue onto Olympic Hwy N>Pass by NAPAAuto Parma-WeMbay Auto Pads>Turn left onto W Vkllace BIvdAMallace Kneeland Bad
Tum right to merge onto US-101 N inward Pod Angeles>Turn led onto N take Cushman Rd>Destination will de on One left 17 1 1 0
81 N Lake Cushman Rd,Hocdl M 98548 y
I O
SIZE MUST RE FLAGGED FROMMNN ROADAND TESTHO!£SNUOTSE FLAOGED WITH TESTHOLENI/NBERS, 10)
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(I mpRup Er-11)
❑VOLUNTARY []MAINTENANCE/PUMPING OBUILDINGPERMIT ❑HOMESALE ❑COMPLAINT []OTHER:
INSPECTOR SOIL LOGS �� ` COMMENTS J
��..� f10 �S '
Aliu 1 4 2U24
CdC�: 0s3 �1E7M �3r �at�r
LY✓c r Z
SOIL canes: � � �� J� 3 DEC. L1R0 R
V=VERY G=GRAVELLY S=SAND L-LOAM SI SILT C=CINv E=EXTREMELY R=ROOT$ REDUIflEO FOR FINALAPPROVAL.
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY DATE
tiWl Li V1 D /2j �" a 10111-1
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED Dv Ds iS
DESIGN FORM -PACE
Assessor's Parcel Number: 4Z2]. - 5 l - I QQQ6
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 layoutsketch,including all applicable items on checklist
■ Scaled plot plan,including all applicable items on checklist ■ Cross-section sketch,i tact uding all applicable items on checklist
This form may be scanned and available for public view on the Mason County Web si te. Maximum paper size: II'X 17"
��,y� ,PARCEL IDENTIFICATION
Permit Number: SWG t -1. _-��' 1CDesigner's Name: Franklin ICfa[k
Applicant's Name: RHOE, LARRY&.MICHELLE Designer's Phone Number: 350.830.4765 - _
Mailing Address: 81 N LAKE CUSHMAN RD Designer's Address: PO Rnx 1954__ __
Cit :HWO WState: WA Zip:%W City Silverdale State:WA Zip:98383
DESIGN PARAMETERS
Treatment Device
Z endon Biofilter Z SandQFiltterr �9 Mound N Sand Lined Drainfield N Recirculating Filter,Type:_ __
Aerobic Unit Make/Model�22.L: 0 Disinfection Unit Make/Modei . Other:_
Drainfield Type
® Pressure A Trench ■ Bed 0 Sub Surface Drip
Septic Tank/Drainfield Specifications Laterals
Number of Bedrooms 2 Schedule/Class Schd 40
Daily Flow: Operating Capacity 240 kW gpd Length - - 288 ft
Daily Flow: Design Flow 240 gpd Diameter t.f ,5—,! In
Septic Tank Capacity 11200 gal Number 4
Receiving Soil Typ e 0-6) 3 Separation 1.25'/25/25/2.5'/ 1.25' ft
Receiving Soil Appl.Rate Prl:.8/Res: .8 gpd/ft' Orifices f
Required Primary Area 240 ft, Total Number of Orifices Xf iGI ^
DesignedPrinrary Arca 240 ft, Diameter 118
A8 in.�„„y
Dc..fgncd Resmvc Arca 300 ft' Spacing in jjQUU��l
Trench/Bed Width 10 IT Manifold
Trench/Bed Length 30 ft Schedule/Class Schd 40
Elevation Measurements Length 2 ft
Original Drainfield Area Slope 2-5 % Diameter 2 in
New Slope,If Altered N/A % Preferred manifold configuration used?2Yes ■ No
Depth of Excavation up-slog 21`i in Transport Pipe
from Original Grade po, slope in Schedule/Class 3034
Designed Vertical Separation in Length 25 ft
Gravelless Chambers Required? 0 Yes ■ No M Optional Diameter J,,A' in
Pump Required? 2 Yes I No Dosing and Pump Chamber
Pump/Siphon Specifications Number ofdoses/day 12
Difference in Elevation Between Pump Shutoffand Uppermost Dose quantity 20 gal
Orifice ---8 - ft Chamber Capacity 1200 gal
Uppermost Orifice■ Higher N Lower than Pump Shutoff Pump controls:Please check those required.
Capacity@ Total Pressure Head 13.8 gam ATimer AElapse Meter 0 Event Counter
Calculated Total Pressure Head 13.6 ft If Timer: Pumpon _ 00/01/00 ,PumPoff 02/00/00 _
Comments
DESIGN FORM -PAGE TWO Assessor's Parcel Number: 422 l 2 - _5l - -144QC2
Permit Number: SWG
OESIGNCHECK LISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
Test hole locations Drainfield orientation and layout Reference depth from original grade:
Soil logs Trench/bed dimensions and Septic tank
Property lines critical distances within layout Drainfield cover
® Existing and proposed wells D-BoxNalve box locations Reference depth from original grade
within 100 ft of property -N/A Septic tank/pump chamber and restrictive strata:
E Measurements to cuts,banks,anc locations I Laterals,trench/bed,top and
surface water and critical areas Observation port location bottom
-N/A Clean-out location E Curtain drain collector-N/A
0 Location and orientation of Manifold placement 0 Sand augmentation - N/A
curtain drain and all absorption ® Orifice placement -N/A Other cross-section detail:
components -N/q Observation ports/clean-outs
J Lateral placement with distance � P
Location and dimension of to edge of bed Other Information
primary system and reserve area
Audible/visual alarm referenced Yes No
Buildings
� Scale of drawing shown on scale ® I Design staked out
Direction of slope indicator bar ® Recorded Notices attached
Waterlines N Waivedsl attached
Roads,easements,driveways, E Pump curve attached
parking ® Evaluation of failure
North arrow and scale drawing Non-residential justification
shown on scale bar ® 0 Waste strength
0 § Flow
DESIGN APPROVAL
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it to be in
compliance with state and local]onsite regulations: q
, Ysul.x,SL,� C(�pjgC-, 09/06/2024
Signature of De er Date `� - -
� �cvrl 6( 1 Ill (Z`1 a
Environmental Health pecalist Date 06 Sept 2024
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
® The design is stamped"Approved"by Mason County Public Health. V 1-50 1Z77
N The Onsite Sewage Permit has not expired,the Permit Expiration Date:s:
N 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 Da[e:12/7/2015
SYMBOLS LEGEND
;sa = Mal I
swffvncAvn `?' �m Egli �2
opt� dR
f� Founm�artFc aa.'Ec m m��
A� 8=m" Sao
rxEFesia>v. z;�
® log
SA^11f51PfIL5APg1 as ^zgm
lv '.A.e1EA 1't1fA a 9 g
0 � Fig
FIE:IFCfi RUNSfTIFF s o �R��
^OJ E�CN I=l KI o m e y
v r1N/40LE g � z a a�
ms�rmurrx ��
O o
EAm6lFR!6PFOIC
"5c A
DW.F OFANF�N'A1fF S.M'IAE
—N- .0LIAF
AFf IIIAf a y
47
mcaw,wuFE vgN� "m
HIM a R I
i'
g§ o
nroa � �oTo
vjs
Sol all
o �A s �k
zN� zo
oil 2
i — Ail 8m
�
m
gg_ o�
0
L
Z
f r °
w
a
m �
o �
_ a
A
N
Qv X
0 3
o c
in J
� N
N
O
J
d
N
S 1
0 -�
w a o a O E^
EX
n V ? 3
W
0
rn
O00
3 _ asaPf xe r8
N
N co -
°or
r s
o n
o
m
mn - ab
.l ?E m 3 N m
m � � ova
C ?cFCD ° d a
1-4 oa O m
m � %
i V1 F m w
O � w
3 0
b � J
� N
O ^
F � r
~ J
C ®C�� CD O n r
z v � 3a
t
nc mf
` xa c gy O
c
c
N nN
00 ^
3 i
—oCO -- -
� o � o
rD
F
B ev rn S � G
00
%32a2=ll VOW111
\ ~ \
.v / .
& / / \ . ,
co
; \ \ \ % {
mI _
-
f ` - ! !}/ _
si
-
) (\ \
! Sa+ G= % ® I :
$ \ { !}
( { ,
;
§ I | §
\ § �] I0 I § . � � \ E /
IEI ) - -
` lo
� ` ! -
R �
-
/ �,
� / { \
;
It
It
/
t , , \ \ \
\ z \ f ( \ ! PiIt _, K / ( \ . rb
\ \\« \z
r
) ( %
\ � { k ` /: 10
r r r m
mr Ar D 1mm 1 o m > > 0 0 0 o
D m 0O N n W (l A C T f1 C m o o a 0 0 0 °' a' n d o - o °� m m o o a a O
nN m1D -iD � r mn � A — rd
T N O A _ O G N V C A m -00
r' m Timm ]gym vn (1 �^ D (1 ''° mm � m ,o v -o� oc
rd N � a N A pn -Z i zS1 Z to Z � s.0o 3 3 .
m N : g rP a rn
3 =.0 D 70 Drm � A � fA11
�• {a 0 T l0 O3 Fr T Z O
O A '� m r l0 vA ^ m v �
300r 0j0 drD !DZ m � H
01
�N
Q. O n 7 !D . Oo�n3mNCZz x x p
W 0 OQNNO �yp N~ NO O OD
0 0O N 030 O
a0 � ° n� Qo
i � on o' a=oIl
oria ®N O ❑
C3n _ �
7 vO
my ❑uCT
N a�0- HW m ^ 0
O rD0Q z `-•q O�. W0;n° 3-s. O n.-mage3N
0Oo.c
N
ON mn
+vON u
fU m C Oin
n 0 { n O j '^ N obi t3 �- 3 q
a S �D J 0 s < 6 0 D' d� m i .. $ o
a m ?r o �- a
3 3 » 3 m a rD Head(Feet) o wp
rD O M1�, m O;
0 n �
Q'
O H Q a � a m � � :3 o N y CO)n ? A O W D` � t0 m .�. � ' No QQ' CD
O
3 rDD mn � .0
Q
n ^ .5'p » 7 '^ = C 7 0 ? m m g m
N p N x O
0 C. Maa m m '�. 3� n s y 0
O n 0 . < O N � M. �. , . . Ir m � o
rD
1 Clio
y a
N an drD
Vr n T b O \ 'n
_ �m JA m ' _ N 0
a ? n 7 -�_ O Q w w
_ N � N ° N in
J a a m D W O p
N 0o N m m m m . Nn .+
_ `n
a = z
= m
(Meters) a' � � A _C3
rD a m CD
Q a C7
g c m C Q
C v� Z ti Q ti Q
n 3 a c Q o O C!
o 3 . 3 a d a
rp
3 o m 3 a a O
o y
rr 3Cn
y
v —
s � O
o o CD,o � i
ry.
o S
s
o
a
> g
o q _
a b+
o q'^ 47 2 N _ a NA
o
o �
N � �
rr �
O
n - O
0
a �
y
0
� c
F
o W O
O p
CL 3 •'.
2 N
!p ^ O
S
0
3 0 z O c c 3 w o r=o rn 3
n a z 54 3 3 3 v
p a x a » tO » D o
_ O m ^. 0 .S. 0 Z !p m d
J N 3 0 O 0 a ti A
r £ Z C D O
D S N < D O G N
3 o-S 0 m
C N
o Z v
O a v Z A Z
r O N O Q f�1 n V
2 rap p + w LA
ox+ m 0
0 < vn, 3k 0 d
_ 0 3 m
o N a D m o
m >
o
m
0 � m nwi * o a '^
m a + wLn 0 S s CD
a m
s 3 0 r �' 0
N 0 'mow
0
N � �
0 o
o a O
a m m + w V
0 L) r
0 4. o W
3?
o O
i2 3 �
�
� �- "�" s a � ,' s �. $# � 3 u one s
Ll e .. O
its yi
o pm '®3 . g 5�,. at @
��� „m m ^r F vi
N N Ol
0 0 � o s m _a •'6 a s A -' - ^ `° 2 0 � � `° o -oJ^. o p_ A o p a _ 3 � 3 � '� r� a � o d
o - - o = or', o - ^ o s Q rri d ti 3 c a
-o F a J a .a m
54
0 3 'oa
'Ci
rrg
e7
FF
� Q 73 N `n Q - " O � F v
fR
A
ERN O p W n N O• O >m Z d d 4. O Z X J d •< O J CtR B
m3
3 a ? �. a = 9:. 3 � d rn rg-. .'^» � _ � -• a a < N o` � m �Jo d
Fb
CD
3 0• o. T; m �. o_ - o. a F o ^o A N 8 a a m 3
E3 CD
3
m J a m
C7
FEr d
m d d ry 3 o a ' J a o - �.. _ d 3 0
lP F a 3 a
T d. d. m
m
A a O- a O n 3 .o d m a A N
Q Orn vi a w r i CD
S v o_
m = o J
oc o s s 3 0 0 !gy!pp
N o ry J o
"a 'o m % SF To
o r� o < o' a csj
4
c
o H a o^ m N A
o
- _
c � a
6 S
to £
rs
➢_ c m kC x CD (U Vi
�' a