HomeMy WebLinkAboutSWG2024-00395 - SWG Application / Design - 9/23/2024 MASON COUNTY 415Nfi SHSTREET, 0427-97 ,E98584
SH STREET,
,SHEL ON, A985"
BELFAIR:360-2754467,EXT400
Public Health & Human Services ELMA 360482-5269,EXT 400
FAX:360-427-7787
On-Site Sewage System Permit: SWG2024-00395
APPLICANT C C M FINANCIAL INC Phone: 206-509-7900
Address: 804 SW 148TH ST SEATTLE, WA 98166
OWNER C C M FINANCIAL INC Phone: 206-509-7900
Address: 804 SW 148TH ST SEATTLE, WA 98166
SEWAGE DESIGNER RICHARD BAZZELL' Phone: 360-509-7900
Address: 165 NW TUPELO WAY POULSBO,WA 98370
Site Address: 151 E Hemingway Ln
Primary Parcel Number: 122063490034
Permit Description: 3-bedroom NuWater BNR500 system: Repair
Permit Submitted Date: 0912312024
Permit Issued Date: 0 9124/2 0 2 4
Issued By: David Anderson
Current Permit Fees Paid: $805.00 I.ddaonm re..may ue neo.i d o.n m wilwon or.y.mml.
Permit Expiration Date: 0 9/2 312 0 2 5 (M.ed on d.le of n.p..eon)
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department sta%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.
IROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
HIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED.
NAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
.or Final Inspection visit:masoncountywa.govlhealthienvironmentallonsiteloss-inspection-request.php or can:
360.427.9670,extension 400.
OFFICIAL USE ONLY
MASON COUNTY w >
0 '.COMMUNITY SERVICES M° N M ENm• c W
MMk NxM lCanmunS MWMEnvNonm¢nGINwBEI a N
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ON-SITE SEWAGE SYSTEM APPLICATION > z
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APPLICAM PNGNE RI m
Susie Watkins - CCM Financial, Inc. 206-650-3908 z
IMILINGMORESS STREET,CRY,STATE,LP COCE z
804 SW 148th Street Seattle WA 98166 AW
SITE ADORsss-srgEST cm,LP C W E
a
151 NE Hemingway Lane Belfair WA 98528
NAME OF OESIGNER PHIXIE I ,v
Caliber Septic Design - Richard Bazzell 360-509-7900 V
NINE OF INSTAUUR PNCNE I N
To Be Determined N/A < I o
PENMITTWE(MCMI) I GRINNING WTTERSW NRCE O
®RESIMImALOSS IDCOMMUNITYOSS COMMERCIAL OSS 11�PRNATE INDIWDUPL WELL �RRNATETW0.PARTY WELL Z I S
TYPEOFWORNPm —) IZPUBLICWATERSYSTEMBMMrWrt ONSWIN
IENEWCONSTRUCTIONIUPGRADES IH_IREPAIRIREPLACEMENT OTHERDETULS(rat WKKfeygL) OTABLE W REPAIR I W
SUMRrtWLS B SURFACING SEWAGE OEXISTINGFAILURE OsHOREUNE W I rT WDESIGNFORM(REOUIRED) USEPTIC DESIGN(REQUIRED) BEDROOMS LOTSQE
pwANER(S)(IFARPLICABLE) 3 0.63 I s
DIRECTIONSTOSREANDBITECONIRRONS.Mxx E N
See attached design for driving directions with local vacinity map. C
PLEASE NOTE: A site evaluation has been completed with Dave Anderson on 8/12/2024. o
SRE MUST BE MODFOTROY MAIN ROAD ANDiE3T XOlE3YVSTBEFUGOED N4111TEBT NOLEMVYBER& I�
OFFICIAL USE ONLY BELOW TN15 LINE
UPGgAOEIFAILURE SOURCE IIm�ep�Mp puryceecj �' 'J
QVOLUNTARY OBMINTENANCEIPUMPMIG OBUILDINGPERMIT OHOMESALE OCOMPL w DOTHER: C
INSPECTOR SOIL LOGS LOMMENTSILONDRgNS
T1tt=0-3q"6Sf- *b0vm fr��4) YFo
TH2:p-X' ¢St foboffom
U- 2Y/29 ( f7St
Reif q f 2Y/Z9 R 1 11
EdLODDEB: RECORD DRAWINGAND INSTA AUON REPORT
V•WRY G•GRAE Y S-SAND L•LO SI•SILT C•GAY E-ENTREMEY R=ROOTS REWIREDFORFINALAPPRUO&
WSPE IONATURE DATE AMIGTIOII IX%RATpI MTE APKK EWISIUED BY DATE
THIS fORMMAY BE SCANNED ANDAVAIIABLE FOR PUBLIC WEWON THE MASON COUNTY WEBS11E REVISED IMM15
DESIGN FORM-PAGE ONE Assessor's Parcel Number: 1 7- b O
A design will be reviewed when 3 copies of each of the fallowing are submitted:
v Completed design form that has been signed and dated. I Scaled layout sketch,including all applicable items on checklist
v Scaled plat plan,including all applicable items on checklist. v Cross-section sketch,including all applicable immune checklist.
This from rosy be scanned and available for public view on the Mason County Web site.MaXlmam ersize: 1]"X 17"
PARCEL IDENTIFICATION
Permit Number: SWG aaaq-OQ!1- 5 Designer's Name: Richard Ba7rell
Applicant's Name: Susie Waddna-CCM Financial Designer's Phone Number: 360-509.7900
Mailing Address: 804 SW 148th Street Designer's Address: 165 NW Tupeto Way
Seatlis WA 981N Poulabo WA 98370
City State Zip
City State Z'
DESIGN P
Treatment Device
D Glendon Biafilter ❑Sand Filter ❑Mound ❑Sand Lined Dminfield ❑Recirculating Filter,Type:
In,Aerobic Unit Make/Model NuWater BNR500 DDisinfection Unit Make/Model Other:
Drainfreld Type
❑Gravity Fl Pressure If Trench D Bed ❑ Sub Surface Drip
Septic Tank/Drainfteld Specifications Laterals
Number of Bedrooms 3 Schedule/Class SCH40
Daily Flow:Operating Capacity 270 gad Length 50 ft
Daily Flow:Design Flow 360 gpd Diameter 1.25 in
Septic Tank Capacity(working) 1250 gal Number 4
Receiving Soil Type(1-6) 4 - Separa 9 It
Receiving Sail Appl.Rate 0.6 - gpd/ft2 ✓ Orifices
Required Primary Area 600 f 2 Tote Orifices 52
Designed Primary Area 600 � ft' Di eYer 9^� 1/8 in
Designed Reserve Area N/A ftc S fig'., . ' T',s 46 in
Trench/Bed Width 3 ft 4` sA&, Manifold
TmuchBed Length 50 r It Wedu146 F$ SCH40
Elevation Measurements Atilido D L BPZZELL DESIGNER 5 ft
D
Original Dminfteld Area Slope 12-15 °/a IW BE 1.25 - in
New Slope,If Altered N/A + % referred manifold configuration used? ffYes O No
Depth of Excavation Us fl p 16.3 - in Transport Pipe
from Original Grade 12 - in Schedule/Ciass SCH40
Designed Vertical Separation 12 - in Length 55 - 11
Gmvellem Chambers Required? ❑Yes D No Mr Optional Diameter 2 - n
Pump Required? of Yes D No Dosing and Pump Chamber
Pump/Siphon Specifications Number ofdosesiday 6
Diff.in Elevation Between Pump&Uppermost Orifice 25-R Dose quantity 45 - gal
Drainfield Squirt Height/Selected Residual(head) 5 rft Chamber Capacity(flood) 1455 — gal
Uppermost Orifice P1Higher D Lower than Pump Shutoff Pump controls:Please check those required.
Capacity Q Total Pressure Head 22.5 gpm E(Timer DElapse Meter ❑Event Counter
Calculated Total Pressure Head 32.2 - R If Timer: Pump on w'^ Pump off 3.98
Comment
PLEASE NOTE:A site evaluation was completed by Dave Anderson on 08112/2024. In addition,the onsite septic system
serving this property has been identified as failed and is under enforcement by Mason County Public Health (Andrea
Tubers).The home was vacated on 09101/2 0 24 and will remain vacant until the onsite septic system is repaired.
DESIGN FORM—PAGE TWO Assessor's Parcel Number: Z- Z. O 90 U 'S
Permit Number: SWG
D H:SIGN C1IECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
El Test hole locations Ed Drainfield orientation and layout Reference depth from original grade:
16 Soil logs 9 Trench/bed dimensions and IY Septic tank
19 Property lines critical distances within layout B Drainfield cover
H Existing and proposed wells 9 D-BoxNalve box locations Reference depth from original grade
within 100 ft of property 9 Septic tank/pump chamber and restrictive strata:
17 Measurements to cuts,banks, and locations B Laterals,trenchlbed,top and
surface water and critical areas H Observation port location bottom
H Location and orientation of 0 Clean-out location ❑ Curtain drain collector
curtain drain and all absorption 9 Manifold placement ❑ Sand augmentation
components M Orifice placement Other cross.section detain
ld Location and dimension of ❑ Lateral placement with distance 19 Observation ports/cleanouts
primary system and reserve area to edge of bed Other Information
0 Buildings M Audible/visual alarm referenced Yes No
19 Direction of slope indicator 9 Scale of drawing shown on scale Ef ❑Design staked out
FJ Waterlines bar ❑ E1 Recorded Notices attached
9 Roads,easements,driveways, ❑ Ig Waiver(s)attached
parking H ❑Pump curve attached
El North arrow and scale drawing A
❑ 9 Evaluation of failure
shown on scale bar Non-residential justification
❑ I f Waste strength
15 Flow
DESIGN O t2G
The undersigned designer must be notified by ms[aller a Edfld4 t JL�pgl°,l�Bes No
'�t ^ , LIC UL1
�'�[-( Gj 2'I
Signatutrilof Design Date q ^A
The undersigned has reviewed this design on behalf of Mason County Public Health and determined it 11�0
_ compliance with state and local on-sitee);e lations:
p Y/?()Z�v—NCpUvjy Fh141074
Environmental Health pecialist Date o N°
CAUTION:The DESign is IGN�APPRROVAdL IS VALID ON"by Mason LY UNDEPublic R THE FOLLOWING
CON7D�I�TI�NN�F*144�,�!
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: // w?
✓ 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: 1217/2015
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