HomeMy WebLinkAboutSWG2021-00329 - SWG Application / Design - 6/4/2021 (2) SHELTON,WA
584
MASON COUNTY 416NBTHELTON: , 0427-97 ,EXT 400
SHELTON:360-275 9 70,EXT 400
BELFAIR:360-2754467,EXT 400
Public Health & Human Services ELMA:360482-5269,EXT 400
FAX 360427-7787
On-Site Sewage System Permit: SWG2021-00329
APPLICANT LUCAS F M &JUDITH L Phone:
Address: 11241 NE North Shore Rd BELFAIR, WA 98528
OWNER LUCAS F M&JUDITH L Phone:
Address: 11241 NE North Shore Rd BELFAIR, WA 98528
SEPTIC DESIGNER ROD LEFT-Acme Design Phone: 360-698-8488
Address: PO Box 2954 SILVERDALE, WA 98383
SEPTIC INSTALLER JUSTIN WELLS' Phone: 360-536-4431
Address: 7124 STATE HIGHWAY 3 SW BREMERTON,WA 98312
Site Address: 11241 NE NORTH SHORE RD
Primary Parcel Number: 322245000051
Permit Description: Repair 2bd pump to gravity-REVISION
Permit Submitted Date: 0610412021
Permit Issued Date: 0 7/0 212 0 21
Issued By: Rhonda Thompson
Current Permit Fees Paid: $1,070.00 (eddltlonal kes may Ee reQuired upon inaklledon otsyaeml.
Permit Expiration Date: 0212812025 (based on dale of nspecdon)
Permit Conditions:
1 Proposed development subject to zoning requirements and approval by the planning
department staffper Mason County Title 17.
2 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
3 Drainfield installation not to exceed designed upslope and downslope depth specified on
design form.
4 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
5 Installer is responsible for obtaining Septic DesignerlEngineer installation approval prior to
backfill of system components.
6 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES,
For Final Inspection visit: masoncountywa.gov/health/onvironmental/onsite/oss-inspection-request.php or call:
360-427.9670,extension 400.
OFFICIAL USE ONLY
MASON CO 09 U Z y
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OSIAYSEWAGE SYSTEM APPLICATION a
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APPLICANT PHONE DID
TODD LUCAS 206-819-6215 z
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MAILINGAOORE55-STREEI,CITY$TAT E,ZIP CODE
1338 ALKI AVE APT 200, SEATTLE WA 98116 m
SITEADORE55-STREET CITY.DP000E A
11241 NE NORTH SHORE RD, BELFAIR 98528 I Lo
NAME OF DESIGNER PHONE I to
LEFT 360-509-2000
NAME OF INSTALLER PHONE O IIV
PEFMM,T PE(.wbc' ) DRINKING.ERSOURCE L/1 I N
U RESIDENTIALOSS IlCOMMUNITYOSS JJCOMMERCIALOSS ®PRIVATE INOVIDUALWELL 51PRIVATETWO-PARTYWELL $ IA
TYPEOFYANK( . .) ®PUBLIC WATER SYSTEM
EPNEWCONSTRUCTION/UPGRADES ®REPAIR/REPLACEMENT OTHER DETAILS r.Ml Mef.,RW El TABLE IX REPAIR I (jl
SUBMITTALS E7 SURFACING SEWAGE O EXISTING FAILURE 0SHORELINE
MDESIGN FORM(REQUIRED) t1:pI SEPTIC DESIGN(REQUIRED) BEDRLVONS LOT S¢E O ICD
RIVAIVER(5)(IF APPLICABLE) 2 34,848 o I 1
DIRECTIONS TO SITE AND SITE CONITIONS.Sub WON) O
REDESIGN TO 2-BEDROOM OSS. WAIVERS ON PREVIOUS SUBMITTAL TO BE I CD
APPLIED. SEE MAP FOR DIRECTION r
0 I
� CID
SITEYNST BE FLAGDEO PROM IMMM R ,XMD TEST HOLES MAST BE RUGGED N TESTMO{E NLMBER3.
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FAILURE SOURCE(W rc tW pu seq
❑VOLUNTARY E3MAINTENANCEPUMPING O BUILDING PERMIT ❑HCMESALE OCOMPLAINT DOTHER:
INSPECTORSOLLOOGGSS COMMENTS/CONDITIONS
IIS �C�
&DILCO
V_VER 0E5:
RECORD DRAWING AND INSTALLATION REFORT
V=VERv O=GRAVELLY S=SAND L=LOAM 9-SILT L=CUV E=EXTREMELY R=RWTS REQUIRED FOR FINAL APPROVAL-
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION LATE AP0.IGTIONAPPROVEMISSUEDBY DATE
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC NEW ON THE MASON COUNIYWEBSITE REVISED WMIS
DESIGN FORM—PAGE ONE Assessor's Parcel Number: 3 2 2 2 4 — 5 0 — 0 0 0 5 1
A design will be reviewed when 3 co pie of each of the following are submitted:
a Completed design form that has been signed and dated. I Scaled layout sketch,including all applicable items on checklist
a Scaled plot plan,including all applicable items on checklist. I Cross-section sketch,including all applicable items on checklist.
This form may be scanned an public view on the Mason County Web site.W unnum r san: 11"X 17"
r d available for PARCELTDENTIFICATION
Permit Number. SWG UV- OO_3" Designer's Name: ROD LEFT
Applicant's Name: TODD LUCAS Designer's Phone Number: 360-698-8488
Mailing Address: 1338 ALKI AVE Designer's Address: P.O.BOX 2954
SFATrLE WA 98528 SILVERDALE WA 9W83
city State zip city State Zip
Treatment Device
❑Glendon Biofilter 0 Sand Filter ❑Mound ❑Sand Lined Dminfield ❑Recirculating Filter,Type:
❑Aerobic Unit Make/Model ❑Disinfection Unit Make/Model Other.
Drainfield Type
EiGtavity ❑Pressure ❑ Trench ❑Bed ❑Sub Surface Drip
Septic Tank/Drainfield Specifications laterals
Number of Bedrooms 2 Schedule/Class 40
Daily Flow:Operating Capacity 180 gpd Length 50 ft
Daily Flow:Design Flow 240 glad Diameter 4 in
Septic Tank Capacity 1250 gal Number 2
Receiving Soil Type(1-6) 3 Separation 5 It
Receiving Soil Appl.Rate 0.8 gpd/ftr Orifices
Required Primary Area 300 ft Total Number of Orifices
Designed Primary Area 300 fe Diameter in
Designed Reserve Area 300 ftt Spacing in
TmncbBed Width 3 ft Manifold
Trench/Bed Length 100 ft Schedule/Class
Elevation Measurements Length it
Original Dminfield Area Slope 30 % Diameter in
New Slope,If Altered 10 % Preferred manifold configuration used? 0 Yes 0 No
Depth of Excavation Upalope 36 in Transport Pipe
from Original Grade Down-slaps 12 in Scheduh/Class 40
Designed Vertical Separation 36 in Length 350 ft
Gmvelless Chambers Required? ❑Yes 0 No Optional Diameter 2 in
Pump Required? Rf Yes 0 No Dosing and Pump Chamber
Pump/Siphon Specifications Number ofdosestday 4.01417EMM15
Difference in Elevation Between Pump Shutoff and Uppermost Dose quantity UJM f ktA�1�gal
Orifice iss ft Chamber Capacity 1250 gal
Uppermost Orifice 0 Higher 0 Lower than Pump Shutoff Pump controls:Please check ose required.
Capacity®Total Pressure Head 10 gpm 1{iTimer Mlapse Meter }Event Counter
Calculated Total Pressure Head 1562 ft If Timer: Pump on /� ,Puummp/offf /
Comment,
RECOMMEND USING A TURBINE WELL PUMP. PUMP TANK TO HAVEATIW RI$EKS!� E D
SEP 23 2024
MASON COUNTY ENVIRONMENTAL HEALTH
RET
DESIGN FORM—PAGE TWO Assessor's Parcel Number.3 2 2 2 4 — 50 -- 00051
0 5 1
Permit Number: SWG
DESIGN CHECKLISTS
Scaled Plot Plan Scaled Layout Sketch Cross-Section Sketch
51 Test hole locations E6 Drainfield orientation and layout Reference depth from original grade:
R1 Soil logs Ef Trench/bed dimensions and Ef Septic tank
m Property lines critical distances within layout 66 Drainfield cover
LA Existingandproposed wells G9 D-Box/Valve box locations
Reference depth from original grade
within 100 ft of property Rf Septic tank/pump chamber and restrictive strata:
Lit Measurements to cuts,banks,and locations 19 Laterals,trench/bed,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:
m Location and dimension of 56 Lateral placement with distance Rf Observation ports/clean-outs
primary system and reserve area to edge of bed
g Other Information
1A Buildings fit( Audiblelvisual alarm referenced Yes No
LJ Direction of slope indicator 66 Scale of drawing shown on scale ❑ Rf Design staked out
m Waterlines bar ❑ 1f Recorded Notices attached
16 Roads,easements,driveways, ❑ Rf Waiver(s)attached
parking [if ❑ Pump curve attached
m North arrow and scale drawing ❑ Gf Evaluation of failure
shown on scale bar Non-residential justification
❑ ❑ Waste strength
❑ ❑ Flow
DESIGN APPROVAL
The undersigned designer must be notified by inset at time inst n Ed Yes ❑ No
Signjp,ff,f 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:
VM
Environmental Health Specialist Date
CAUTION: DESIGN APPROVAL IS VALID ONLY UNDER THE FOLLOWING CONDITION:
✓ The design is stamped"Approved"by Mason County Public Health. /;, a}„
✓ The Onsite Sewage Permit has not expired,the Permit Expiration Date is: ��/�r Jb I fA
✓ 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: 12/7/2015
Pump Selection for a Non-Pressurized System Single Fxriy Residence Project
LU CAS/32224-50-00051
Parameters
E 450
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Calculatioro
TasPaV1¢y Da ps —, 300
e
Frktior+al Head lases LL
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Pipe Volumes m 200
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Minimum Pump Requirements 150
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100
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Net Discharge(gpm)
PumpData Legend
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APPROVED
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SEP 2 3 2024
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RET
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